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SANJOAQUIN <br />-- COUNTY as2de <br />Greatness grows here <br />Environmental Health Department <br />LI Boring Installation <br />METHOD USED <br />Boring Destruction <br />Monitoring Well/Soil Boring Inspection Report <br />Inspector: <br />Z5151 t COt <br />Well#: <br />Date: <br />Facility Addres <br />Well Address: <br />WP# 00 <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Soil Boring#: <br />Drilling Company: Takpx <br />Driller Onsite: <br />Consultant: WALL( t —1Lki'M 401`15064 <br />Geologist: PArt-eik. • <br />Public Water System Onsite: CI Yes EINo <br />Domestic Well Onsite: CI Yes IIINo <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: LI Yes 111No <br />SPOILS <br />Contamination Noted: LI Yes ONo <br />If yes, spoils storage Location: <br />Covered: LI Yes ONo <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: AJj oat.A--t V <br />Grout Material: Pnt <br />Gallons of of Grout Used: <br />111Pressure Grout DOver Drill <br />qGravity ETremie DOther: <br />Water <br />gallons <br />Cement 471b <br />Bags _ _ <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest #Bags Thickest Thinnest # Bags <br />2.5 5 1 i---"- 5 10 1 <br />5 10' 2 if 10 20 1 <br />7.5 15 3 15 30 3 <br />10 20 4 20 40 4 <br />12.5 25 5 25 SO 5 <br />15 30 6 30 60 6 <br />17.5 35 7 35 70 7 <br />20 40 8 40 80 8 <br />Min 2" Annular EHD Seal Verified: LI Yes ON° <br />To: <br />To: <br />To: <br />To: <br />COMPLETION CI Stove Pipe DChristie Box <br />casing <br />height <br />CHRISTY-130X <br />COMPLETION <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank Feet Screen Feet <br />Slot Size: <br />Bags of Cement: <br />Bags Sand/Gravel: <br />Type/Brand of Bentonite: <br />Filter Pack Type/Size: <br />Type of Method: <br />Bentonite/Cement Mix 3% Mix 5% Mix <br />Bentonite per 47 lb 1.41 2.47 <br />Bentonite per 94 lb 2.82 4.7 <br />7_ c\eul. <br />LI Well Installation 111 Well Destruction <br />10/16/2017 <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjcehd.com <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />From: <br />From: <br />From: <br />From: