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SA N J OAQ U I N—COUNTY— Environmental Health Department -,;,_, Greoiness grows lire. / Monitoring Well/Soil Boring Inspection Report Date: 1 ZZ Inspecto4�iOv �l�cJ G CONSTRUCTION Facility Address: 0 Zo S. ti ctoc k(-w/L- Well Addr Total Depth: WP# V 0 000 Well#: Drilling Rig Type: Soil Boring#: ?_ 3 f Min 2"Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company: P Driller Onsite: Screen Length From: To: Consultant: �/� w �+�eci�i'><- ..Lti- 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: height SAMPLING JlBOYE-GROUND Holding Temperature: COMPLE SON c�tEfiON Method: Gmnd Sumacs Screening Method: groat Verified Chain of Custody: ❑ Yes ❑No ft. ft. ft. SPOILS Contamination Noted: ❑ Yes ❑No r r If yes,spoils storage Location: ; . = .2 atottad ya .,_ � — $ Covered: ElYes ❑No saccnN If yes, material: -= GROUTING or DESTRUCTION Total Depth: CW 15 _— Depth to Water: —ft. — ft• Grout Material: �f C e n e, ,t MATERIALS/DEVELOPMENT Gallons of Grout Used: 14 O -foil C_U Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet El Boring Installation;N�- Slot Size: oring Destruction Bags Size: Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravity Xremie ❑Other: Type of Method: Water Cement 471b Water Cernent 94lb gallons Bags gallons Bags Thickest Thinnest .:Bags Tlkkest Thinnest 11Bags Bentonite/Cement Mix 3% Mix 5% Mix 2.5 5 1 5 10 1 Bentonite per 47 lb 1.41 2.47 5 10 2 10 20 2 Bentonite per 94 lb 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 60 6 17.5 35 7 35 70 7 20 40 8 40 80 0 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