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ABOVE-GROUND <br />COMPLETION <br />SANAOAQUIN <br />1 -- COUNTY <br />c,d5:er„. .st.,Foce/ Greatness grows herr <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: /0-07.5i/ Inspector: /14-ice4.- <br />Facility Address: g-'y iOrey4,:voraily <br />Well Address: <br />VVP#Ji01/2,46/ <br />Soil Boring#: /di/ <br />Drilling Company: rerifit472e1— <br />Driller Onsite: <br />Consultant: " <br />Geologist: ..6 3-02.--7 217 <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: <br /> 111 Yes ENo <br />Screen Length From: <br /> <br />To: <br />Filter Pack From: <br /> <br />To: <br />Bentonite From: <br /> <br />To: <br />Grout From: To: <br />Well#: <br />Public Water System Onsite: 111 Yes EN° <br />COMPLETION 111 Stove Pipe <br /> <br />EChristie Box <br />Domestic Well Onsite: CI Yes ENo <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />casing <br />height <br />CHRISTY-BOX <br />COMPLETION <br />Ground Surface <br />Screening Method: <br />Verified Chain of Custody: <br /> El Yes 111No <br />SPOILS <br />Contamination Noted: <br /> <br />III Yes <br />If yes, spoils storage Location: <br />LI Yes <br />gel GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: )7 <br />Gallons of Grout Used: <br />111Well Installation 111Well Destruction <br />El Boring Installation gt'ring Destruction <br />METHOD USED <br />IIIPressure Grout DOver Drill <br />E Gravity RTremie 1110ther: <br />Water <br />gallons <br />Cement 47Ib <br />Bags <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest # Bags Thickest Thinnest 8 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 5 <br />15 30 6 30 60 6 <br />17.5 7 35 70 7 <br />20 <br />,:rp5 <br />fr7 40 80 8 <br />71.5 <br />grout <br />ft <br /> ft <br />—ft <br />gravel pack <br />Ii 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 />Covered: <br />If yes, material: <br />oft-- Grout Material: /ipe* ce/rv7 <br />Warted <br />aacton <br />ft. <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjcehd.com