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SAN JOAQUIN COUNTY cq";;O'p - &e.utness grows her(. Environmental Health Department Monitoring Well/Soil Boring Inspection Report Date: '0-/b ell Inspector: i/V Orn Water gallons CONSTRUCTION Thickest Thinnest Facility Address: Well Address: �, Thickest Thinnest A'/'otal Depth: 2. 5 l c� C t� �� WP# ) , f Well#: ;, Drilling Rig Type: 10 20 Soil Boring#: Drilling Company: 7.5 15 M`1114 �,� Min 2" Annular EHD Seal Verified: 1-1 Yes ❑No �. 4 20 40 4 12.5 25 5 Driller Onsite: 5 15 30 Screen Length From: To: Consultant: l'-, P o5. �►�t+ec 7 Filter Pack From: To: Geologist: T Q 40 80 Bentonite From: To: Grout From: To: Public Water System Onsite: ❑ Yes 0 N COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes ❑No If yes, location and distance: SAMPLING Holding Temperature: Method: Screening Method:_ Verified Chain of Custody wnii c Contamination Noted ❑ Yes ❑ No ❑ Yes ❑ No If yes, spoils storage Location: Covered: ❑ Yes ❑No If yes, material: GROUTING or DESTRUCTION Total Depth: Depth to Water: Grout Material: Gallons of Grout Used: ❑Well Installation ❑Well Destruction ❑Boring Installation,Boring Destruction METHOD USED �'J�° ❑Pressure Grout ❑Over Drill ❑ Gravity mie ❑Other: Water allons Cement 471b Bas Water gallons Cement 941b Bags Thickest Thinnest s Thickest Thinnest 4 Bags 2. 5 s 10 1 5 10 2 10 20 2 7.5 15 3 15 30 3 10 20 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 casing height ABOVE -GROUND C4iRt51Y-SOX COMPLETION COMPLETION Ground Sumacs grout ft. tt. _ y O — a slotted s*ricn tt. 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.secehd.com