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SAN JOAQUIN Environmental Health Department COUNTY— �lS�� c9�,F as P' Greatness grows here. It A 111"t 3 oil Boring Inspection Report Date: e%5'�1 Inspector: ww S-ohn CONSTRUCTION Facility Address: Well Address: 1(1"13r Ifc"0-0.- M Total Depth: WP# 003,y5-q'/ Well#: Drilling Rig Type: Soil Boring#: Min 2" Annular EHD Seal Verified: ❑ Yes El No Drilling Company: C-wa-Ile AP.CG Driller Onsite: 7o.t�G Screen Length From: To: Filter Pack From: To: Consultant: Geologist: Bentonite From: To: Grout From: To: Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes ❑No casing If yes, location and distance: height SAMPLING ABOVE-c aoUNo _ Holding Temperature: CONFLITION CC#APLEncN Method: G=nd Surface Screening Method: M ori Verified Chain of Custody: ❑ Yes El No i--n' tt. ft. SPOILS Contamination Noted: ❑ Yes 11 No — e If yes, spoils storage Location: slatted aKSon — B Covered: ❑ Yes ❑No _ g-vw P-k If yes, material: GROUTING or DESTRUCTION Total Depth: oo� Ir _= Depth to Water: n- n' Grout Material: Sol ids MATERIALS/DEVELOPMENT Gallons of Grout Used: 744' Casing Type: Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation ❑Boring Destruction Bags iz Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravity WTremie ❑Other: Type of Method: Water Cement 471b Water Cement 941b allons Bas gallons Bags Thickest Thinnest #Bags Thickest Thinnest NBags Bentonite/Cement Mix 3% Mix 5% Mix 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 5 10 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 7.5 15 3 15 30 3 0 20 4 20 40 4 1 2s s 2s s0 s 3z b SD �bS A)& A, �'''•� R'"�°�d 15 30 6 30 60 6 s e125 0 0 0044 Wild 10/16/2017 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s*cehd.com