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SAN JOAQUIN COUNTY--- ``4,,Rear` Greotness grows here. Environmental Health Department Monitoring Well/Soil Boring Inspection Report Public Water System Onsite Domestic Well Onsite: If yes, location and distance: Grout From ❑ Yes J:;lNo COMPLETION ❑ Stove Pipe ❑ Yes ,;BNo SAMPLING Holding Temperature: Method: Screening Method: Verified Chain of Custody: ❑ Yes El No SPOILS Contamination Noted: ❑ Yes �o If yes, spoils storage Location: Covered: If yes, material: ❑ Yes ❑ No GROUTING or DESTRUCTION Total Depth:—I(,;.,�2� Depth to Water: owiLt Grout Material:M Gallons of Grout Used: z-.. ❑Well Installation ❑Well Destruction ❑Boring Installation Xoring Destruction MFTlar)r) I KIM ❑Pressure Grout ❑Over Drill Gravity ❑Tremie ❑Other: Water allons Cement 471b Bas Date: t 1. "Ie ��'� Inspector: ru CONSTRUCTION Facility Address: �� 'DIE Thickest Thinnest Well Address:► 2.5 Total Depth: WP# (k77 1' " Well#: Drilling Rig Type: Soil Boring#: N1 5 10 Drilling Company: - t ' L'1� 9 J r tt ( Min 2" Annular EHD Seal Verified: Driller Onsite: VolScreen 7.5 Length From: Consultant: 1, of tiD Filter Pack From: Geologist: tum L`It/ "," Bentonite From: Public Water System Onsite Domestic Well Onsite: If yes, location and distance: Grout From ❑ Yes J:;lNo COMPLETION ❑ Stove Pipe ❑ Yes ,;BNo SAMPLING Holding Temperature: Method: Screening Method: Verified Chain of Custody: ❑ Yes El No SPOILS Contamination Noted: ❑ Yes �o If yes, spoils storage Location: Covered: If yes, material: ❑ Yes ❑ No GROUTING or DESTRUCTION Total Depth:—I(,;.,�2� Depth to Water: owiLt Grout Material:M Gallons of Grout Used: z-.. ❑Well Installation ❑Well Destruction ❑Boring Installation Xoring Destruction MFTlar)r) I KIM ❑Pressure Grout ❑Over Drill Gravity ❑Tremie ❑Other: Water allons Cement 471b Bas water allons Cement 94 lb Bags Thickest Thinnest uBags Thickest Thinnest )tBags 2.5 5 1 5 10 1 5 10 2 10 20 2 7.5 5 15 30 3 10 0 4 20 40 4 12.5 25 5 25 50 5 15 30 6 30 60 6 17.5 35 7 35 70 7 20 40 8 40 80 8 ❑ Yes El No To: To: To: To: []Christie Box WTcasing height ABOVE -GROUND CHR1STY-BOX COMPLETION COMPLEncN Ground surface proLn ft. _ o slonad = 2—W Pack tt.IF IF ft. MATERIALS/DEVELOPMENT Casing Type: Blank Feet Slot Size: Bags of Cement: Bags Sand/Gravel: Type/Brand of Bentonite: Filter Pack Type/Size: Type of Method: Screen Feet Bentonite/Cement Mix 3% Mix 5% Mix Bentonite per 47 Ib 1.41 2.47 Bentonite per 94 Ib 2.82 4.7 10/16/2017 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s'cehd.com