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Date:9/2 V-2!3,11--A I nspe.Aor: <br />Facility Address: .019 1 1"'1A./ <br />"S. C <br />Well#: <br />Public Water System Onsite: Yes IllNo <br />Domestic Well Onsite: • Yes No <br />Well Address: <br />WP# 001"1 <br />Soil Boring#: <br />Drilling Company: <br />Driller Onsite: <br />Consultant(i VI <br />Geologist: <br />414 <br />casing <br />height <br />ABOVE-GROUND <br />COMPLETION CHRISTY-80X <br />COMPLETION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: CI Yes LENo <br />To: <br />To: <br />To: <br />To: <br />COMPLETION 111 Stove Pipe lilChristie Box <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />From: <br />From: <br />From: <br />From: <br />LI Gravity "$.Tremie 1.'1-P1/C:then <br />A <br />OBoring Installation LI Boring Destruction <br />METHOD USED <br />Pressure Grout 'Over Drill <br />SANJOAQUIN <br />COUNTY <br />Environmental Health Department <br />\ <br />Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />CONSTRUCTION <br />If yes, location and distance: <br />SAMPLING <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: <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: 0 vtk, <br />Grout Material: <br />Gallons of Grout Used: <br />Well Installation ell Destruction <br />Water <br />gallons <br />Cemen 471b <br />Bag <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest 4 Bags 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 20 40 4 <br />12.5 25 5 25 50 s <br />15 30 6 30 60 6 <br />17.5 35 7 35 70 7 <br />_20 4EL 8 ito 80 8 <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 />Yes EIN0 <br />Yes ON° <br />Yes lilNo <br />Q 61.9S <br />Icik Li I bo <br />1868 E. H zelton Avenue I Sto kt <br />p <br />on, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjcehd.com <br />10/16/2017