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Total Depth: <br />Drilling Rig Type: 14sA- 9 1( <br /> <br />Min 2" Annular EHD Seal Verified: El Yes lilNo <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />From: <br />From: <br />From: <br />From: <br /> <br />To: <br />To: <br />To: <br />To: <br /> <br />SANdOAQUIN <br />COUNTY <br />Greatness grows here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Dat6 InApecZ: CONSTRUCTION <br />Facility Ad ress: 29 5 y figtyy 0 ci rae, <br />Well Addyess: <br />WP#009 eiT-3 Well: <br />Soil Boring#: —63s 1 e loi t I <br />Drilling Company: -fe,r-raz,0 ii <br />Driller Onsite: rir (— <br />Consultant: <br />Geologist: y IA44%441 <br />Public Water System Onsite: 111 Yes COMPLETION El Stove Pipe lilChristie Box <br /> <br />Domestic Well Onsite: LI Yes nNo casing <br />height <br /> <br />If yes, location and distance: <br /> <br />SAMPLING <br />Holding Temperature: <br />Method: <br /> <br />AVE-GROUND <br />COMPLETION <br /> <br />CHRISTY-BOX <br />COMPLETION <br /> <br />Ground Surfacs <br /> <br />EINo 1 <br />gr g°I gal IS <br />li1No <br />elLf. g° <br />Screening Method: <br />Verified Chain of Custody: LI Yes <br />SPOILS <br />Contamination Noted: LI Ye <br />If yes, spoils storage Location: <br />Covered: <br />If yes, material: <br />GROUTING or DESTRUCTION Total <br />Depth to Water: n _ <br />Grout Material: At.e4k-t- <br />Gallons of Grout Used: 'IQ-0 e-1 <br />LI Well Installation ClWell Destruction <br />CI Boring Installation VBoring Destruction <br />METHOD USED <br />El Pressure Grout DOver Drill <br />jeGravity 111Tremie <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 />Y es <br />Depth: <br />Einioiss to <br /> 66: <br />I5$-F-t , <br />tS <br />6i :IS ' <br />Blo: ' MATERIALS/DEVELOPMENT <br />I11 10 Casing Type: <br />Water <br />gallons <br />Cemen(4.711....)8 <br />Bags <br />Water <br />gallons <br />Cement 94Ib <br />Bags <br />Thickest Thinnest 4Bags Thickest Thinnest 4Bags <br />2.5 5 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 />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 />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjcehd.com <br />(4o 9 D-1 25 .s