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raaN, Z� �I�eS <br /> SAN JOAQUIN <br /> SAN. <br /> N. u N TY - Environmental Health Department <br /> iFoa pJ Greatness grows here. <br /> Mon' ori ell/Soil Boring Inspection Report <br /> . <br /> Date. / inspector: CONSTRUCTION <br /> P � <br /> Facility Address: <br /> Well Address: O ki Total Depth: 1 <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: ' �6ylf1"tzsc Min 2" Annular EHD Seal Verified: El Yes ❑No <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: WT <br /> height <br /> SAMPLING ABCVE-GROUND <br /> Holding Temperature: COMPLETION COWLEMON <br /> Method: Ground Sur}°" <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No -�-n' <br /> it. <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No r° <br /> If yes, spoils storage Location: <br /> sacdon — <br /> Covered: El Yes ❑No y = gr,wlPaCK <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: A =_ <br /> Depth to Water: n• n' <br /> Grout Material: lGir <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> )&% <br /> ell Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest 4Bags Thickest Thinnest 4Bags Bentonite/Cement Mix 3% 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 /> 10 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 ev <br /> 15 30 6 30 60 6 <br /> Ka 10 35 7 35 70 71 /20 40 8 40 80 8 /�� r/� �' / 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />