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crawl pack <br />ft. Jr <br />COMPLETION LI Stove Pipe li1Christie Box <br /> <br />—ft <br />casing <br />height <br />61-IFItSTY430X <br />CCMPLET1ON <br />Ground Sudan <br />grout <br />ft <br />ft <br />slotted <br />soclon <br />SAN.DJOAQUIN <br />COUNTY <br />Greatness cirovs's here. <br />W P# 00,315t-; 24, Well#: <br />Soil Boring#: <br />ef. %,•J r) <br />Driller Onsite: <br />Consultant: <br />Geologist: <br />Public Water System Onsite: El Yes LINo <br />Domestic Well Onsite: El Yes li1No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: El Yes El N o <br />SPOILS <br />Contamination Noted: El Yes El N o <br />If yes, spoils storage Location: <br />Covered: 1E1 Yes LINo <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: Ty- a, <br />Depth to Water: V1-413- <br />Grout Material: ..-ve.,NiC <br />Gallons of Grout Used: <br />Well Installation Destrction <br />LI Boring Installation El Boring Destruction <br />METHOD USED <br />Pressure Grout l'‘er Drill <br />III Gravity fmie ClOther: <br />Water <br />gallons <br />Cement 47Ib <br />Bags <br />Water <br />gallons <br />cement 94Ib <br />Bags <br />Thickest Thinnest #Bags Thickest Thinnest flags <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 s <br />15 30 6 30 60 6 <br />17.5 35 7 35 70 7 <br />20 40 8 40 80 8 <br />Environmental Health Department <br />Boring Inspection Report <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: E Yes 1:1No <br />To: <br />To: <br />To: <br />To: <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 />Monitoring Well/Soil <br />Date: Inspector: La.— <br />Facility Address: 11:16"J 0 <br />Well Address: <br />Drilling Company: <br />Screen Length From: <br />Filter Pack From: <br />Bentonite From: <br />Grout From: <br />10/16/2017 vv..4.1." rtAl <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjcehd.conn