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SAN JOAQUIN Environmentai Health Department —COU NTY— \�rFoa`6�s Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date: b-17-11 Inspector: CONSTRUCTION Facility Address: 22re oP 61, Well Address: Total Depth: WP#d0g'7k1P Well#: Drilling Rig Type: Soil Boring#: 5✓P- I, Z 13 Min 2"Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company: �/)tnccv�L A-.zc�`.Y-� Driller Onsite: G•rdrrSL Screen Length From: To: Filter Pack From: To: Consultant: Geologist: .�lirt� Bentonite From: To: Grout From: To: Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes ❑No casing If yes, location and distance: height SAMPLING ABOVE-GACUND CNAIsrY-BOX Holding Temperature: COMPLETION COMPLETION around srxfao. Method: Screening Method: grout Verified Chain of Custody: ❑ Yes El No ft. _ SPOILS rV — m Contamination Noted: ❑ Yes ❑No = r If yes, spoils storage Location: slatted sacdon Covered: ❑ Yes ❑No = 9 Pack If yes, material: Wit` GROUTING or DESTRUCTION Total Depth: IS Depth to Water: /VO L Grout Material: /VC,rc-7 «► a MATERIALS/DEVELOPMENT Gallons of Grout Used: 2-1 z 2-5, 2-!a Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation XBoring Destruction Bags of Cement: METHOD USED Bags Sand/Gravel: Type/Brand of Bentonite: ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: ❑ Gravity ❑Tremie ®-Other: Aee A-e Type of Method: Water Cement 471b Water Cement 941b allons Bags gallons Ba s Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 5% Mix 2.5 5 1 5 10 1 Bentonite per 47 Ib 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 1 7 35 70 7 20 40 1 B 40 80 8 10/16/2017 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.secehd.com