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SANr10A UIN <br /> 4e ;, <br /> Environmeir,di Health Department <br /> —COUNTY— <br /> '5ti���aas:� Greatness grows here. <br /> (((��� onit 'ng Well/Soil Boring Inspection Report <br /> Date: Inspector: CONSTRUCTION <br /> Facility ddress: ' <br /> Well Address: Total Depth: '�t,���p <br /> WP# O `\\O\ Well#: S(n ' /5�.Ian Drilling Rig Type:�Qr1�0 VA&W 6 <br /> Soil Boring#: KhM1V_UTC_00'1 56 %IDIN-0 \3If <br /> Drilling Company:�[S`1 QVc®��y Min 2"Annular EHD Seal Verified: Yes ❑No 3 i <br /> Screen Length From: <br /> Driller Onsite: �Stl To: <br /> Consultant: PRtt,� N�9- !W(: ' <br /> Filter Pack From: To: <br /> Geologist: Slat) AA' Bentonite From: �nT To: <br /> kYes <br /> Grout From: To:�Public Water System Onsite: ❑No COMPLETION ElStove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes �No casing <br /> If yes,location and distance:— height <br /> SAMPLING AeovE,t3aotlND CHFIWTY43OX <br /> Holding Temperature: ociwLtT1oN cdnaLETloN <br /> Method: Ground rrlacs .�- <br /> Screening Method: grout <br /> 1 7*ro <br /> Verified Chain of Custody: ❑ Yes ❑No —4 ft. <br /> —ft. <br /> SPOILS _— <br /> Contamination Noted: ,— ❑ Yes El No <br /> i <br /> If yes,spoils storage Location swnad <br /> Ncd°n <br /> Covered: Yes ❑No — g,vWpack <br /> If yes,material: S> <br /> i <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: ft• ft' gF cat o �Gc`� <br /> Grout Material: Qa c P 'r <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> Well Installation *ell Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑�B°ring Installation ❑Boring Destruction <br /> Bags of Cement: <br /> METHOD USED �Q Bags Sand/Gravel: <br /> El Pressure Grout Over Drill Type/Brand of Bentonite: <br /> \ Filter Pack Type/Size: <br /> Gravity ❑Tremie ❑Other: Type of Method: <br /> Water cement 471b Water Cement 941b <br /> allons Bags eallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest p0ags _ BentonitelCement Mix 3%MIX 5% MIX <br /> s s 19 1 Bentonite per 47 Ib 1.41 2.47 <br /> 10 z 10 20 2 Bentonite per 94lb 2.8214.7 <br /> 15 3 15 30 3 <br /> 10 20 4 20 40 4 <br /> 12.5 25 5 25 s0 5 <br /> 15 30 6 30 6o 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 BO 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.s6cehd.com <br />