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SAN J OAQ U I N Environmental Health Department t.. fu—;,' -- C O U N T Y Greatness grows here. Monitoring/Well/Soil Boring Inspection Report Date: I Oc 2 Inspector: A �A_ • CONSTRUCTION Facility Address: i2 OSa Eve4►yr -f Well Address: Total Depth: wP# 00 9161 '3 —We ll#: Drilling Rig Type: Soil Boring#: Min 2" Annular EHD Seal Verified: 11 Yes ❑No Drilling Company: i Yl Driller Onsite: Screen Length From: To: Consultant: V *7 Filter Pack From: To: Geologist: Bentonite From: To: Grout From: To: Public Water System Onsite: ❑ Yes No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes ❑No casing If yes, location and distance: WT height SAMPLING AWVE-GROUND Holding Temperature: 00�"P��N comPLEncN Method: Ground Sumac+ Screening Method: grout Verified Chain of Custody: ❑ Yes ❑No •�—tt' tt. tt. SPOILS Contamination Noted: ❑ Yes ❑No C If yes, spoils storage Location: abed _ c- on i Covered: ❑ Yes ❑No = gna-4 v If yes, material: GROUTING or DESTRUCTION Total Depth: >: __ Depth to Water: �. 4 n• IF —IF ft. Grout Material: Gallons of Grout Used: ^— 1Q MATERIALS/DEVELOPMENT Casing Type: ❑Well Installation VWell Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation ❑Boring Destruction Bags of Cement: METHOD USED Bags Sand/Gravel: ver Drill Type/Brand of Bentonite: El Pressure Grout)40 Filter Pack Type/Size: ❑ Gravity YTremie ❑Other: Type of Method: Water //////Cemen 471b Water Cement 941b allons Bas vall ons Bags Thickest Thinnest NBags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 3° 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 C,2.47 5 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 25 5 25 50 5 15 30 6 30 1 60 6 17.5 35 7 35 1 70 7 20 40 8 40 1 80 8 ,,— t do Inn 10/16/2017 1868 E.Lelton Avenue I Stock on, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.secehd.com