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SAKJOAQUIN <br />Environmental Health Department <br />f COU N T Y <br />Cement 941b <br />Bags <br />Greatness grows here. <br />ttBags <br />Well/Soil <br />Boring Inspection Report <br />Monitoring <br />Date: ZI Inspector: �`/l D— <br />CONSTRUCTION <br />Facility Address: <br />1 <br />Well Address: <br />Total Depth: <br />WP#6OLI 7,249 Well#: <br />Drilling Rig Type: <br />Soil Boring#: al ,goZ <br />Min 2" Annular EHD Seal Verified: ❑ Yes El No <br />Drilling Company: <br />3 <br />Driller Onsite: <br />Screen Length From: To: <br />Consultant:`O—Can <br />Filter Pack From: To: <br />Geologist: Y LA, f, AAM <br />Bentonite From: To: <br />25 50 <br />Grout From: To: <br />Public Water System Onsite: ❑ Yes El No <br />COMPLETION ❑ Stove Pipe ❑Christie Box <br />Domestic Well Onsite: ❑ Yes ❑No <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 />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑No <br />GROUTING or DESTRUCTION Total Depth: o 5 _P �x <br />Depth to Water: 0 <br />Grout Material: &IOZe1*1 <br />Gallons of Grout Used:d <br />❑Well Installation ❑Well Destruction <br />❑Boring InstallationXBoring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ GravityVTremiie�Other: <br />Water <br />gall s <br />Cement 71b <br />Bas <br />Water <br />Rall ons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />ttBags <br />Thickest Thinnest <br />"Bags <br />2.5 5 <br />1 <br />5 10 <br />1 <br />5 10 <br />2 <br />10 20 <br />2 <br />7.5 15 <br />3 <br />15 30 <br />3 <br />10 20 <br />4 <br />20 40 <br />4 <br />12.5 25 <br />5 <br />25 50 <br />5 <br />15 30 <br />6 <br />30 60 <br />6 <br />17.5 35 <br />7 <br />35 70 <br />7 <br />20 40 <br />8 <br />40 80 <br />8 <br />!3h S <br />1868 E. Hazelton Avenue I Sckton, California 95205 <br />casing <br />height <br />_ T <br />ABOVE -GROUND CHRtM43OX <br />COWPLETION COMPLETION <br />Ground sur+ac. —T <br />grout <br />R. <br />it. <br />— a <br />atonad = $ <br />saclon <br />craw+ paces <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank 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 />Screen Feet <br />Bentonite/Cement Mix 3% Mix 5% Mix <br />Bentonite per 47 Ib 1.41 2.47 <br />Bentonite per 94 Ib 2.82 4.7 <br />10/16/2017 <br />T 209 468-3420 1 F 209464-0138 1 www.s*cehd.com <br />