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SANIJOAQUIN <br />—COUNTY— <br />Greatness grows here <br />ft. <br />casing <br />height <br />CHRiSTY4BOX <br />COMPLETION <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: LI Yes lilNo <br />To: <br />To: <br />To: <br />To: <br />COMPLETION CI Stove Pipe lilChristie Box <br />Ground Surface <br />grout <br /> tt <br />—ft <br />slotted <br />s•cdon <br />tt <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />From: <br />From: <br />From: <br />From: <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: '10) 2.'1121- Inspector: (..5(Alilik6US <br />Facility Address:\\2 1 IALCV1 1:\Vt - <br />Well Address: <br />WP# 06-k3C)Gle3 Well: <br />Soil Boring#: \-\ - Cc)14,-; cytt <br />Drilling Company: COVNtk--e <br />Driller Onsite: oyik), <br />Consultant: --\(.v.\ P\6116,-, <br />Geologist: <br />Public Water System Onsite: El Yes ON° <br />Domestic Well Onsite: El Yes EN° <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: 111 Yes ON° <br />SPOILS <br />Contamination Noted: CI Yes EN° <br />If yes, spoils storage Location: <br />Covered: LIYes ON° <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: <br />Grout Material: r\eict- ettne.,A3-. <br />Gallons of Grout Used: cy,\ <br />LI Well Installation OWell Destruction <br />11 Boring Installation Ii4Boring Destruction <br />METHOD USED <br />EPressure Grout ElOver Drill <br />111 Gravity 4Tremie DOther: <br />Water <br />gallons <br />Cement 471b <br />Bags <br />Water <br />gallons <br />Cennent941b <br />Bags <br />Thickest Thinnest #Bags Thickest Thinnest #Bags <br />2.5 5 1 v 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 />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank Feet Screen <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 />sC'D <br />Feet <br />10/16/2017 <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 j F 209 464-0138 I www.sjcehd.com