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co SANJOAQUIN Environmental Health Department J COUNTY----- / Greatness grows here t Monist/,o^ring Well/Soil Boring Inspection Report Date: J 120-4 ZE Inspector: &kOV`Ut Fir CONSTRUCTION , /r Facility Address: I`qq-�I C_ f�l( �Y�, I�L� b r Well Address: Total Depth: WP# 0 01-kC) Well#: Drilling Rig Type: Soil Boring#: tX 1b 62--QL4 Min 2" Annular EHD Seal Verified: ❑ Yes El No Drilling Company: Driller Onsite: j"iiy Screen Length From: To: Consultant: yU-thl Filter Pack From: To: Geologist: Dtv el Bentonite From: To: Grout From: To: Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes ❑No casing If yes, location and distance: WT height SAMPLING Asove-GROUND Holding Temperature: CONFLETION cCC APLEnON Method: Ground Surf"y Screening Method: ar«n Verified Chain of Custody: ❑ Yes El No �ft. tt. ft. SPOILS Contamination Noted: ❑ Yes El No — If yes, spoils storage Location: siorted sao�on — Covered: ❑ Yes El No = lane If yes, material: GROUTING or DESTRUCTION Total Depth:_ Depth to Water: NO C- Vq tL ft. Grout Material: Gallons of Grout Used: MATERIALS/DEVELOPMENT Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet ❑Boring Installation ❑Boring Destruction Slot Size: Bags of Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravity ❑Tremie ❑Other: Type of Method: Water Cement 471b Water Cement 94Tb- gallons Bas eallons Bags Thickest Thinnest 9Bags Thickest Thinnest u659s 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 1 3 15 30 3 10 20 1 4 20 40 4 12.5 25 5 25 50 5 15 30 6 30 60 6 17.5 35 7 35 70 7 20 40 8 40 80 8 W l GINS w oC r la :r f 10/16/2017 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.slcehd.com