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SAN J OAQ U I N Environmental Health Department COUNTY-- Monitoring Well/Soil Boring Inspection Report Date:3 19l 9 Inspector: Uv mc, CONSTRUCTION Facility Address: LT�� ' 5 . 1� Well Address: y I ih� Total Depth: WP# WAW: -� �� Drilling Rig Type: Soil Boring#: �. i Drilling Company: q-� Min 2" Annular EHD Seal Verified: El Yes El No ,- 5 1 Driller Onsite: rc.ni► Screen Length From: To: Consultant: Filter Pack From: To: Geologist: Bentonite From: To: Grout From: To: Public Water System Onsite: ❑ Yes � COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes ❑No casing If yes, location and distance: height SAMPLING ABQVE.GROUND Holding Temperature: COWFLETION CC _oMPt_PTION Method: G=nd Surf xs Screening Method: a�«n Verified Chain of Custody: ❑ Yes El No �_ft. ft. ft. SPOILS = Contamination Noted: ❑ Yes El No — m If yes, spoils storage Location: aaron Covered: ❑ Yes ❑No 9-81 Pack If yes, material: _= GROUTING or DESTRUCTION Total Depth: ��x3 Z3'A 1 _ Depth to Water:— L)("-gft tt Grout Material: MATERIALS/DEVELOPMENT Gallons of Grout Used: 4-r Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring InstallationBoring Destruction Bags of Cement: METHOD USED Bags Sand/Gravel: Type/Brand of Bentonite: ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: )4Gravity ❑Tremie ❑Other: Type of Method: Water Cement 471b Water Cement 941b allons Bas Rations Bags Thickest Thinnest tlBags Thickest Thinnest NBags Bentonite/Cement Mix 3% Mix 5% Mix 2,5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 s 10 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 7.5 15 3 15 30 3 10 20 4 20 40 4 12.5 a 25 50 5 n 30 0 6 ` 17.7. 7 5 35 7 35 70 7 20 40 8 40 80 8 'tlJ \v` 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