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CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular END Seal Verified: 0 Yes ON° <br />To: <br />To: <br />To: <br />To: <br />Screen Length From: <br />Filter Pack <br /> <br />From: <br />Bentonite From: <br />Grout <br /> From: <br />ABOVE-GRC4JND <br />COMPLETION CHFIISTY-BOX <br />COMPLETION <br />SAN JOAQUIN <br />COUNTY <br />Environmental Health Department <br />Greatness grows here <br />Monitoring Well/Soil Boring Inspection Report <br />Date: /2--\13 -ZA, Inspector:. <br />Facility Address: I 4. 3--01 (j), <br />Well Address: <br />WP# 0041(01-1 We11#: <br />Soil Boring#: <br />Drilling Company: Ca.c3atoe <br />Driller Onsite: <br />Consultant: h) r- r‘ — "Ti ) -f-vvc)i r-te/5 <br />Geologist: ka \ V 1 <br />Public Water System Onsite: LI Yes 0No COMPLETION D Stove Pipe CIChristie Box <br />Domestic Well Onsite: D Yes 0 No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: 111 Yes 0No <br />SPOILS <br />Contamination Noted: 0 Yes 0N0 <br />If yes, spoils storage Location: <br />Covered: 0 Yes DNo <br />If yes, material: <br />GROUTING or DESTRUCTIQD,N Total Depth: 576 <br />Depth to Water: <br />Gallons of Grout Used: /\-- ()Oat et-A • <br />Grout Material: COAA 2A4- <br />LII Well Installation 0 Well Destruction <br />0 Boring Installation Boring Destruction <br />METHOD USED <br />0Pressure Grout DOver Drill <br />0 Gravity <br /> <br />*remie 00ther: <br />Water <br />gallons <br />Cement 47Ib <br />Bags <br />Water <br />gallons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest 4Bags Thickest Thinnest 4 Bags <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 Li 20 40 4 <br />12.5 _ 25 5 I/ 25 50 5 <br />15 30 6 1.--- 30 60 6 <br />17.5 35 7 c ,' 35 70 7 <br />20 40 8 i---' 40 80 8 <br />casing <br />height <br />Ground Surfacs <br />_ft <br />slottad <br />&act° n <br />ft <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 />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjcehd.com