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SAN:.°JOAQUIN Environmental Health Department <br /> —COU NTY--- <br /> Greatness grows here. <br /> I Q F Q Mooni.ttoring('Well/Soil Boring Inspection Report <br /> Date: L/OI` 1 Inspector. � t0� T�D�� C11- CONSTRUCTION <br /> Facility Address: S. mo-y'w S� <br /> Well Address: Total Depth: <br /> WP# a 3 ©;2-q Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: �,i-.�Cov� Min 2"Annular EHD Seal Verified: El Yes El No <br /> Driller Onsite: e<SS� Screen Length From: To: <br /> Consultant: 'e r -o,-C a✓� Filter Pack From: To: <br /> Geologist: Ky-, S Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: 0016PLETION COMP�LEnoN <br /> Method: °ro`o'dSurfaos + <br /> Screening Method: 0 grout <br /> Verified Chain of Custody: ❑ Yes El No �ft. <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: abnad = <br /> aadon — B <br /> Covered: ❑ Yes El No = cr+va+pack <br /> If yes, material: (1, <br /> GROUTING or DESTRUCTION Total Depth: X <br /> Depth to Water:- <br /> 4e*— <br /> Grout Material: 'E MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: ( (4 o` <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation Shoring Destruction 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 47lb Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 5%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 <br /> P <br /> 30 6 30 60 6 <br /> 5 35 7 35 70 7 <br /> 40 8 40 80 8 <br /> a jS 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 www.socehd.com <br />