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E Stove Pipe COMPLETION E Christie Box Public Water System Onsite: LI Yes 111No <br />Ground Surfac• <br />casing <br />height <br />ABOVE-GROUND <br />COMPLETION CHRISTY-80X <br />COMPLETION <br />Domestic Well Onsite: E Yes ENo <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />111 Yes ENo Covered: <br />If yes, material: <br />Screening Method: <br />Verified Chain of Custody: LI Yes El o <br />SPOILS <br />Contamination Noted: CI Yes EN° <br />If yes, spoils storage Location: <br />GROUTING or DESTRUCTION To al Depth: <br />Depth to Water: s <br />Grout Material: <br />Gallons of Grout Used: A.,0 <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: LI Yes ILiNo <br />To: <br />To: <br />To: <br />To: <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />From: <br />From: <br />From: <br />From: <br /> <br />SANAAQUIN <br />COUNTY <br />Greatness grows here <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 3/t 4/7--I Inspector: I A-• <br />Facility Address1024 <br />Well Address: <br />WP# OP -1-9f <br />Soil Boring#: .f -t- -z cir-r <br />Drilling Company: //1 /01 ra„--H, <br />Driller Onsite: <br />Consultant: (err e4f-S-400._ C;e1--1/7 <br />Geologist: t <br />Well#: <br />EWell Installation DWell Destruction <br />E Boring Installation tf43oring Destruction <br />METHOD USED <br />LI Pressure Grout EOver Drill <br />III Gravity <br /> <br />)kremie 00ther: <br />Water <br />gallons <br />Cem en 471b <br />Bag <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest # Bags Thickest Thinnest # Bags <br />2.5 5 1 5 10 1 <br />5 10 10 20 2 <br />7.5 15 015 30 3 <br />10 20 20 40 4 <br />12.5 25 s 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 />Blank Feet Screen <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 />Feet <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjcehd.com