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ABOVE-GROUND <br />COMPLETION <br /> SA6JOAQUIN <br />z4.1.-4) COUNTY .,,Otator7 <br />Greatness grows here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 55 Zer"" InspectoretAr <br />Facility Address: /roe 7401W 4"" <br />Well Address: <br />vvp# ys z-ao <br />Soil Boring#: <br />Drilling Company: ,.//r7 <br />Driller Onsite: C,4•41 <br />Consultant: <br />Geologist: e205 <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: E Yes 0No <br />From: To: <br />From: To: <br />From: To: <br />From: To: <br />Well#: <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />Public Water System Onsite: 0 Yes lii No COMPLETION E Stove Pipe DChristie Box <br /> <br />Domestic Well Onsite: 0 Yes E No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />casing <br />height <br />CHRISTY-BOX <br />COMPLETION <br />Ground Su-lac* <br />grout <br />Verified Chain of Custody: El Yes E No <br />SPOILS <br />Contamination Noted: E Yes El No <br />If yes, spoils storage Location: <br />Covered: EIYes 0No <br />If yes, material: <br />cee f Ac : L'1° <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />GROUTING or DESTRUCTION Total Depth: 6/ — <br />Depth to Water: Xf <br />Grout Material: /Will ,M 's,? <br />Gallons of Grout Used: <br />E Well Installation 0Well Destruction <br />E Boring Installation Boring Destruction <br />METHOD USED <br />0Pressure Grout 00ver Drill <br />Ri/Gravity Tremie ElOther: <br />r • <br />Water <br />gallons <br />Cement 47Ib <br />Bags <br />Water <br />gallons <br />Cement 94Ib <br />Bags <br />Thickest Thinnest # Bags Thickest Thinnest #Bags <br />2.5 ..5,...-- 1 .....— 5 10 1 <br />s 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 />P <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 wvwv.sjcehd.com