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SAN JOAQUIN Environmental Health Department COUNTY— ,, „ Greatness groves here. Monitoring Well/Soil Boring Inspection Report Date: I(7— Inspector: pyr raze CONSTRUCTION Facility Address: Well Address: 601- Aeuj Total Depth: WP# !Ae Z?(31 Well#: mw--as" Drilling Rig Type: Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company: CiQ?S5 Driller Onsite: Screen Length From: To: Consultant: ,d -2c Filter Pack From: To: Geologist: F; 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: � height T. SAMPLING ABOVE-GROUND r COWLETION C -BOX Holding Temperature: caOMPLEtelETloN Method: Ground Suiace 7_ Screening Method: grout Verified Chain of Custody: ❑ Yes El No —tt• ft. SPOILS — T Contamination Noted: ❑ Yes ❑No If yes,spoils storage Location: elonea - s section Covered: ❑Yes ❑No — gravol Pack If yes, material: //� GROUTING or DESTRUCTION Total Depth: 13� Depth to Water: Grout Material: qv/ «� Gallons of Grout Used: ZC,q MATERIALS/DEVELOPMENT Casing Type: ❑Well Installation XWell Destruction Blank Feet Screen Feet ❑Boring Installation ❑ Slot Size: Boring Destruction Bags of Cement: METHOD USED Bags Sand/Gravel: Type/Brand of Bentonite: El Pressure Grout Plover Drill Filter Pack Type/Size: ❑ Gravity IXTremie ❑Other: Type of Method: Water Cement471b Water Cement 941b allons Bags ealtons Ba s Thickest Thinnest #Bags Thickest Thinnest #Bags BentOnitelCement MIX 8%MIX 5% MIX 2.s s 1 s 10 1 Bentonite per 47 lb 1.41 2.47 s 10 2 10 20 2 Bentonite per 94lb 1 2.821 4.7 7.5 15 3 15 30 3 10 20 4 20 40 4 s 25 5 25 50 5 i C D �0Vv�w6 U}� 5 30 6 30 60 6 � "� 0 17.5 35 7 35 70 7 20 40 8 40 80 8 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