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i <br /> SANJOAQUIN Environmental Health Department <br /> U;I,. :.. —COU NTY— I <br /> pAA l <br /> Greatness grows here. <br /> W <br /> nspection Report <br /> Date: 12 1A(I Inspector 1aVYN -I CONSTRUCTION <br /> Facility dd ss: ) 1' %q , � , �t��-1'In_ ,►��'v►�-F�C� <br /> Well Address: Total Depth: <br /> WP#_003af (�,3� Well#: Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Compamo 5ei(! i S T-)c 11,11, 1 V\ Screen Length From: To: <br /> Driller Onsite: �VYCWX. 1C_, <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: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: OC&F'LE ION COM LE ON <br /> Method: of°""d S`a'oe <br /> Screening Method: <br /> Verified Chain of Custody: ❑ Yes El No <br /> tt. <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No = <br /> If yes,spoils storage Location: ,10tUd = <br /> ssc'on — <br /> Covered: ❑ Yes El No — <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: V)0 cA)a tom/ ft• ' — ft <br /> Grout Material: V)d - 10. 3 <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: S2._ if-e(9tD <br /> i T— Casing Type: <br /> ❑Well Installation ell Destruction Blank Feet Screen Feet <br /> El Boring Installation/❑Boring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> ❑ Gravity ( Jemie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> gallons Bas gall ons Bags <br /> Thickest Thinnest ttBags Thickest Thinnest PBags 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 / nn <br /> 15 30 6 30 60 b I Q GJa yidC��v�� vc <br /> 17.5 35 7 35 70 7 <br /> 20 40 0 40 80 6 <br /> V��II (A� S G �'�� 10/16/2017 <br /> 40 ' oe-�o"re- �t fa. io o" <br /> 1868 E. Hazelton Avenue Stockton, California 95205 T 209 468-3420 1 F 209 464-01 8 1 www.sicehd.com <br />