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SANJOAQUIN <br />ifr_ COUNTY— <br />Ogr, oa r' Greotness grows here. <br />Environmental Health Department <br />Mon, i�t)oring Well/Soil Boring Inspection Report <br />Dater - IS Inspector: �`' CONSTRUCTION <br />Facility Addr ss:a ? S & L►/`p 1--� ...,11 <br />Well Address: Total Depth:. <br />WP# Well#: Drilling Rig Type: • �� l I c� -A <br />Soil Boring#: <br />—VSKlin 2" Annular EHD Seal Verified <br />Drilling Company: '-�--P " �' f-Cf� %Screen Length From: <br />Driller Onsite: e c��i -Q . 6 - <br />Consultant: —� \ Filter Pack From: <br />Geologist: _ n� �Si� 1 Bentonite From: <br />/ <br />out From: <br />Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe <br />Domestic Well Onsite: <br />If yes, location and distance: <br />❑ Yes <br />El No <br />SAMPLING <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />Holding Temperature: <br />Thickest Thinnest <br />tlBags <br />Method: <br />5 <br />1 <br />Screening Method: <br />1 <br />5 <br />Verified Chain of Custody: <br />❑ Yes <br />El No <br />SPOILS <br />7.5 <br />15 <br />Contamination Noted: <br />❑ Yes <br />❑ No <br />If yes, spoils storage Location: <br />20 <br />4 <br />Covered: <br />❑ Yes <br />❑No <br />If yes, material: <br />5 <br />25 50 <br />❑ Yes ❑No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />casing <br />height <br />ABOVE -GROUND CHRLS7Y4M <br />CONFLETION COMPLEMN <br />Ground surtax <br />grout <br />n. <br />ft. <br />ft. _ <br />0 <br />— o <br />siottad <br />soon — B <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: %1 /pk tt• n' <br />Grout Material: t <br />Gallons of Grout Used: MATERIALS/DEVELOPMENT <br />Casing Type: <br />❑Well Installation ❑Well Destruction 51 vJas Blank Feet Screen Feet <br />4411^^ Slot Size: <br />El Boring Installation oring Destruction �{�,r <br />dnl 5l 3Y''^� Bags of Cement: <br />METHOD USED i t��yBags Sand/Gravel: <br />-to, dr�ll��, �'Ir'-((' Type/Brand of Bentonite: <br />❑Pressure Grout ❑Over Drill 'r° 10 h55 ai- f;II.e.J Filter Pack Type/Size: <br />AGravity ❑Tremie ❑Other: c4f-� Type of Method: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />RBags <br />Thickest Thinnest <br />tlBags <br />2.5 <br />5 <br />1 <br />5 10 <br />1 <br />5 <br />10 <br />2 <br />10 20 <br />2 <br />7.5 <br />15 <br />3 <br />15 30 <br />3 <br />10 <br />20 <br />4 <br />20 40 <br />4 <br />12.5 <br />25 <br />5 <br />25 50 <br />5 <br />15 <br />30 <br />6 <br />30 60 <br />6 <br />17.5 <br />35 <br />7 <br />35 70 <br />7 <br />20 <br />40 <br />8 <br />40 80 <br />8 <br />Bentonite/Cement Mix 3% Mix 5% Mix <br />Bentonite per 47 Ib 1.41 2.47 <br />Bentonite per 94 Ib 2.82 4.7 <br />10/16/2017 <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.sucehd.com <br />