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SAN JOAQUIN Environmental Health Department <br /> --COUNTY - - <br /> C oring Well/Soil Boring Inspection Report 101di ., <br /> Date: / % Inspector: Imo'lJ & , CONSTRUCTION — �5 ( C6,yj4' <br /> Facility Address: w.e(e&p-: 4 <br /> Well Address: I 1Mo ,p Total Depth: 3 -O <br /> 0-�ry 9z 41A� <br /> WP# 003S4t _Well#: f�'Il well Drilling Rig Type: � <br /> �� �r <br /> Soil Boring#: <br /> Drilling Company: O i�'/'Dr'Q <br /> Min 2" Annular EHD Seal Verified: es ❑No 100r <br /> Driller Onsite: �p reen L th From: To: g YbK-� <br /> Consultant: ' Filt ck From: To: <br /> Geologist: Be on' e From: To: <br /> Grout From: 119 To: 5 � <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: height <br /> SAMPLING �t <br /> ABOVE-GROUND Ctffa15TYSox <br /> Holding Temperature: CO1iPLETION 3. NcomPLEnois <br /> Method: Grou Sudan <br /> Screening Method: �f.0u4V gro«n <br /> Verified Chain of Custody: ❑ Yes El No sejVL <br /> 100 n. <br /> SPOILS 0. I•►J�� <br /> v <br /> Contamination Noted: ❑ Yes El No coke- <br /> If <br /> okeIf yes, spoils storage Location: UI kffip _ <br /> Covered: El Yes ❑No = 9_„w Pack <br /> If yes, material: <br /> SealEE <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: n n' <br /> Grout Material: OC <br /> GUsed" /U MATERIALS/DEVELOPMENT <br /> Gallons of Grout <br /> Casing Type: <br /> Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> rte, Filter Pack Type/Size: <br /> ❑ Gravity NlTremie ❑Other: Type of Method: <br /> Water ,,Cement 471b Water Cement 941b <br /> allons Bas eallons Bags <br /> Thickest Thinnest 9Bags Thickest Thinnest uBags Bentonite/Cement Mix 8% Mix 3% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 7.5 15 3 15 30 3 <br /> 1 20 4 20 40 4 <br /> 12..5 25 5 25 50 5 <br /> 15 30 6 30 60 6 �/, // <br /> 17.5 35 7 35 70 7 W <br /> 20 40 8 40 80 8 _ <br /> x �6 1'. �� 10/16/2017 <br /> 1868 E. Hazelton a Stockton, California 95205'1 T 209 468=3420 11 5 209 464-0138 1 www.slcehd.com <br />