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7,3 <br />1 ' <br />SANJOAQUIN <br />COUNTY—/ <br />Greotness grows here. <br />Environmer 'Health Department <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Yes El No Covered: <br />If yes, material: <br />LI Gravity remie nOther: <br />CI Stove Pipe COMPLETION <br />Screen <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank Feet <br />Slot Size: <br />Well#: <br />Public Water System Onsite: El Yes ON° <br />Domestic Well Onsite: El Yes ON° <br />If yes, location and distance: <br />Screening Method: <br />Verified Chain of Custody: <br />SPOILS <br />Contamination Noted: <br />If yes, spoils storage Location: <br />GROUTING or DESTRUCTION Total Depth:t <br />56 <br />i ii Depth to Water: / 0 ZA-'S) • <br />Grout Material: i..4- c.......4.......4----- <br />Gallons of Grout Used: 1 f; <br />liWell Installation El Well Destruction <br />El Boring Installation ff8';g Destruction <br />METHOD USED <br />EPressure Grout I dyer Drill <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: <br />Screen Length From: <br />Filter Pack From: <br />Bentonite From: <br />Grout From: <br />Bags of Cement: <br />Bags Sand/Gravel: <br />Type/Brand of Bentonite: <br />Filter Pack Type/Size: <br />Type of Method: <br />Date: <br />Facility A dress: <br />Well Address: <br />WP# <br />Soil Boring#: ea- so <br />Drilling Company: <br />Driller Onsite: <br />Consultant: <br />Geologist: <br />Monitoring Well/Soil Boring Inspection Report <br />7nspector: 0 CONSTRUCTION <br />ev-1/414 <br />60.0 -CAAA_ <br />Yes LINo <br />El Yes El o <br />Yes lilf\lo <br />To: <br />To: <br />To: <br />To: <br />EChristie Box <br />Feet <br />Water <br />gallons <br />Cement 47Ib <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 5 10 2 10 20 2 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 40 80 a <br />Bentonite per 94 lb <br />Bentonite per 47 lb <br />Bentonite/Cement Mix 3% Mix <br />2.82 <br />1.41 <br />5% Mix <br />2.47 <br />4.7 <br />"Als 10/16/2 017 <br />1868 E. Hazelton Avenue! ockt <br />/ <br />on, Caltfo ia 95205 f 1 209 468-3420 l F 209 464-0138 www.sicehd.com <br />casing <br />height <br />Alit3VE-oROUND <br />COMPLETION ChiFilSTY-E.OX <br />COMPLETION <br /> ft