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SANAOAQUIN <br /> —COUNTY— Environmental Health Department <br /> Greatness grows here. <br /> Mon,,ittori_n�gtWell/Soil Boring Inspection Report <br /> Date: y 2OZa Inspector: LSA `►`GCJ' CONSTRUCTION <br /> Facility Address: 1750 'Wya n z jk , 7ra / <br /> Well Address: � Notal Depth: <br /> WP# Well#: Drilling Rig Type: g 1-LSA}' <br /> Soil Boring#: 1 Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: oila ,(�tsr `tsv+ <br /> Driller Onsite: �O(/ , _ Screen Length From: To: <br /> Consultant: k Filter Pack From: To: <br /> Geologist: e loa"ai& 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 El No casing <br /> If yes, location and distance: IffT height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COMPLETION COMPPLE oN <br /> Method: Ground Surface' + <br /> Screening Method: grow <br /> Verified Chain of Custody: ❑ Yes ❑No �tt' <br /> f:. <br /> tt. <br /> SPOILS . <br /> Contamination Noted: ❑ Yes ❑No = <br /> C <br /> If yes,spoils storage Location: afonaa <br /> sec-ion <br /> Covered: ❑ Yes ❑No = gr„s,Pack <br /> If yes, material: = <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: ^_? n• te. <br /> Grout Material: RIAr <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring InstallationlBoring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> 4Gravity ❑Tremie ❑Other: Type of Method: <br /> Water C ent 47lb Water Cement 941b <br /> gallons Bas gallIll ons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 3% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> s 10 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 7.5 3 15 30 3 <br /> 10 20 40 4 <br /> 12.5 25 5 25 so 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <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.secehd.com <br />