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N SAN JOAQUIN COUNTY ---- Environmental Health Department Monitoring Well/Soil Boring Inspection Report Date: A� C&LI Inspector: `x; r:*v � ` CONSTRUCTION Facility Address: LO),O D>t: jim &lye �k Well Address:Total Depth:_ WP# 4 -5lv � Well#: Drilling Rig Type: Soil Boring#: Min 2" Annular EHD Seal Verified ❑ Yes ❑ No Drilling Company: A q IA4 Cement 471b Bas Water Pallons _ Driller Onsite: "( �cwkt.+( �tIVU >r" 4L> Screen Length From: To: Consultant: L Filter Pack From: To: Geologist: Vy't Bentonite From: To: 5 Grout From: To: Public Water System Onsite: ❑ Yes ;Z'No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite If yes, location and distance: SAMPLING Holding Temperature: Method: Screening Method:_ Verified Chain of Custody: rysu10 Contamination Noted If yes, spoils storage Location: Covered: ❑ Yes ,L; No ❑ Yes ❑No ❑ Yes ❑ No ❑ Yes ❑No If yes, material: GROUTING or DESTRUCTION Total Depth: l Depth to Water: t Grout Material: Gallons of Grout Used: n. ❑Well Installation ❑Well Destruction ❑Boring Installation Boring Destruction METHOD USED ❑Pressure Grout ❑Over Drill ❑ Gravity PTremie ❑Other: Water allons Cement 471b Bas Water Pallons Cement 941b Bags Thickest Thinnest 9Bags Thickest Thinnest ttBags 2.5 5 1 5 10 1 5 10 2 10 20 2 7.5 15 3 15 30 3 10 20 4 20 40 4 12.5 2 25 50 5 15 30 6 30 60 6 17.5 35 7 35 70 7 20 40 8 40 80 8 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