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SAN JUAQUIN <br />COUNTY <br />Greatness grows here. <br />Environmental Health Department <br />Gravi.tvs remie 00ther: <br />Feet Blank Feet Screen <br />Slot Size: <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 71Z Inspector:, <br />Facility Address: 0 864 .1-4 <br />Well Addrgs: <br />WP#A0 Well#: <br />Soil Boring#: /0,4, <br />Drilling Company: 0T-tom-- <br />Driller Onsite: s <br />Consultant: j-fat 41- <br />Geologist: al 0-5 <br />Public Water System Onsite: LI Yes 0No <br />Domestic Well Onsite: 0 Yes 0N0 <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: 111 Yes IIINo <br />SPOILS <br />Contamination Noted: 111 Yes LINo <br />If yes, spoils storage Location: <br />Covered: 0 Yes LINo <br />If yes, material: <br />i <br />GROUTING or DESTRUCTION Total DeptIleito <br />k <br />73 <br />Depth to Water: Wa k <br />Grout Material: /reit-- rto"eigif <br />Gallons of Grout Used: <br />El Well Installation CI Well Destruction <br />CI Boring Installation IR(3oring Destruction <br />METHOD USED <br />OPressure Grout 00ver Drill <br />. , <br />Water <br />gallons <br />Cement 471b <br />Bags <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest # Bags Thickest Thinnest # 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 /A4 4 <br />12.5 25 s 25 0 <br />15 30 6 30 lel' 6 <br />17.5 35 7 35 70 7 <br />20 40 8 40 80 8 <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: CI Yes LIN° <br />To: <br />To: <br />To: <br />To: <br />LIChristie Box <br />casing <br />height <br />ABOVE-GROUND <br />COMPLETION CHRLSTY-BOX • <br />COMPLETION <br />Ground St.:dace <br />grout <br />-ft <br />ft- <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Bags of Cement: <br />Bags Sand/Gravel: <br />Type/Brand of Bentonite: <br />Filter Pack Type/Size: <br />Type of Method: <br />BentonitelCement Mix 3% Mix 5% Mix <br />Bentonite per 47 lb 1.41 2.47 <br />Bentonite per 94 lb 2.82 4.7 <br />11'1 444wa <br />1(41 04vf i r <br />10/16/2017 <br />1RAR F 1-1a7eltnn AVern ip I Rtnrktnn Q911 I T 2119 4RR-1.49(1 I F 9nq 4s4_n1 I wxyly sir.ehri rnm <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />From: <br />From: <br />From: <br />From: <br />COMPLETION 111 Stove Pipe