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SAN-JOAQUIN Environmental Health Department —COUNTY-Greatness grows here. Monii__torin/g� Well/Soil Boring Inspection Report Date: Z Inspector: _�c l4t✓Di< 6k+.y, CONSTRUCTION Facility Address: 3'l Od L61, Sin Well Address: Total Depth: WP# CCN 2$10 Well#: Drilling Rig Type: Soil Boring#: `L✓ ^- 2l fl�3t� Min 2" Annular EHD Seal Verified: El Yes 11 No Drilling Company: Driller Onsite: Screen Length From: To: Consultant: Filter Pack From: To: Geologist: Q��,,�; Y- 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-GROUND _ Holding Temperature: COAPLEi10N COMPLEnoN Method: around Surfx. Screening Method: Grout l« Verified Chain of Custody: ❑ Yes No —'n' ft. it. SPOILS Contamination Noted: ❑ Yes ❑No =" — If yes, spoils storage Location: slotted = B a�c�on Covered: ❑ Yes El No If yes, material: �, _ .. GROUTING or DESTRUCTION Total Depth: _- Depth to Water: A- a ft. IFft Grout Material: ne,4 Gallons of Grout Used: MATERIALS/DEVELOPMENT Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation [QBoring Destruction Bags iz Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravity K)Tremie ❑Other: Type of Method: Water Cement I Water Cement 941b allons Bas allons Bags Thickest Thinnest ttBags Thickest Thinnest tlBags Bentonite/Cement Mix 3% Mix 5%Mix 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 s 10 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 7.5 15 3 15 30 3 10 20 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 `� �NI� 10/16/2017 1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-3420 I F 209 464-0138 www.socehd.com