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SAN 'JOAQUIN Environrnental Health Department <br /> COUNTY— <br /> °9,,, P` Greatness grows here. <br /> Myonitppo��rinlgnWell/Soil Boring Inspection Report <br /> Date: I Inspector: FI1�YiyN V� CONSTRUCTION <br /> Facility Address: S(lb f, yoy�t�F_ <br /> Well Address: LA.Z \-iQX,,R , LP Total Depth: <br /> WP# ®K) 3 a Well#: Drilling Rig Type: <br /> Soil Boring#: LK'T - I S - Z2 71� (P 8oquh <br /> Lin 2„Annular EHD Seal Verified: 11 Yes ❑No <br /> Drilling Company: AAT 0S) ��t,�� �►�-o- t�1�TINC^ Screen Length From: To: <br /> Driller Onsite: jLkQN <br /> Consultant: get, n St�y S A55or:TATiESFilter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes �No COMPLETION ❑ Stove Pipe El Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COMPLErtON CCOMP�LETiON <br /> Method: c3rocmcsutac' <br /> Screening Method: grout <br /> I <br /> Verified Chain of Custody: ❑ Yes El No T n. <br /> t. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes,spoils storage Location: slonad <br /> _ <br /> asc.cn <br /> Covered: ❑ Yes ONO <br /> :a; — gravN prk <br /> If yes, material: <br /> GROUTING r DESTRUCTION Total Depth: 'T I� 50 ('f 4tz <br /> —_ <br /> epth to Water: t2 �Wk . n — <br /> Grout Material: WW GIF1M001c MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation [ Slot Size: <br /> Boring Destruction Bags Size: <br /> Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> []Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity ITremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas vallons Bags <br /> Thickest Thinnest .Bags Thickest Thinnest NBags Bentonite/Cement Mix 3%Mix 5%Mix <br /> 2.5 s 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 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 /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 00 6 <br /> 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 />