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Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: 111 Yes DNo <br />To: <br />To: <br />To: <br />To: <br />COMPLETION El Stove Pipe <br />casing <br />height <br />El Christie Box <br />CHFUSTf-80X <br />COMPLETION <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />From: <br />From: <br />From: <br />From: <br />SAI\LJOAQUIN <br />COUNTY <br />Greatness grows here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: I, \ \c\ty.\ Inspector: <br />Facility Address: \'-) S \ SCZ <br />Well Address: c-DC45\44-,--c.c2.4c) cf-- <br />WP# "\\\e Ncp Well#: 13 / <br />Soil Boring#: <br />Drilling Company: <br />Driller Onsite: vvr; <br />Consultant: <br />Geologist: P/IN <br />Public Water System Onsite: <br /> <br />0 Yes [7fN o <br />Domestic Well Onsite: <br /> <br />0 Yes ErN o <br />If yes, location and distance: <br />SAMPLING 010\ <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: <br />SPOILS ( <br />Contamination Noted: <br />If yes, spoils storage Location: <br />Covered: 0 Yes 0No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: )-,' <br />Grout Material: <br />Gallons of Grout Used: L. <br />El Well Installation DWell Destruction <br />0Boring Installation Boring Destruction <br />METHOD USED <br />E Pressure Grout DOver Drill <br />0 Gravity 171Tremie El Other: <br />Water <br />gallons <br />Cement 471b <br />Bags <br />Water <br />gallons <br />Cement 94Ib <br />Bags <br />Thickest Thinnest # Bags Thickest Thinnest #Bags <br />2.5 ri, 1 5 10 1 <br />5 10 2 10 20 2 <br />7.5 15 3 15 30 3 <br />10 20 4 20 40 4 <br />12.5 25 5 25 50 5 <br />15 30 6 30 60 6 <br />17.5 35 7 35 70 7 <br />20 40 8 40 80 8 <br />CONSTRUCTION <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 />10/16/2017 <br />ID Yes 0No <br />0 Yes 0No <br />.v‘ <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjcehd.com