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SAN-JOAQUIN Environmenku, Health Department <br /> IS r --COUNTY— <br /> ' Greatness grows here. <br /> Morn on Well/Soil Boring Inspection Report <br /> Date: �� Inspector: <br /> CONSTRUCTION <br /> Facility Address: Q <br /> Total Depth: <br /> Well Address: tlgiS <br /> W P# <br /> �\\uqp?2 Well#: �5 1- ,��cG L DrillingRigType: <br /> Soil Boring#: N I� Min 2" Annular EHD Seal Verified: El Yes El No <br /> Drilling Company: c���ca Screen Length From: To: <br /> Driller Onsite: o��r' Filter Pack From: To: <br /> �R _ G.� 4- yt 9� To: <br /> Consultant: Bentonite From: <br /> Geologist: '[0 `0 66FA>,knX — Grout From: To: <br /> Public Water System Onsite: kyes ❑No COMPLETION ❑ Stove Pipe []Christie Box <br /> causing <br /> Domestic Well Onsite: ❑Yes No height <br /> If yes, location and distance: 7WW-f <br /> _- <br /> AwvE-GROUND c4inks Y-BOX <br /> SAMPLING cowLETION C40,wLETION <br /> Holding Temperature: Ground Sus+'°'— <br /> Method: grout <br /> Screening Method: _ft. <br /> Verified Chain of Custody: ❑Yes ❑No ft. <br /> SPOILS � <br /> Contamination Noted: !]Yes �N° <br /> .I#.yes,spoils storage Location: t—� <br /> suction <br /> ftYes ❑No or"r°l� <br /> Covered: <br /> If yes,material: <br /> GROUTING or DESTRUCTION Total Depth: ft = tt• <br /> Depth to Water: G" ft <br /> Grout Material: k1t r t �ns�.� ^^nT°t2tetc/DEVELOPMENT <br /> Gallons of Grout Used: ' l lA � — Casing Type: Feet <br /> Blank— <br /> kw Feet Screen <br /> ❑Welllnstallation eIlDestruction Slot Size: <br /> ❑Boring Installation ElBoring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> (�( Type/Brand of Bentonite: <br /> ❑Pressure Grout Qlpver Drill Filter Pack Type/Size: <br /> ((��VVVVV ����\ Type of Method: <br /> ❑ Gravity 'LXlremie - ❑Other: <br /> Cement 471b Water Cement 941b <br /> Water Be s <br /> all as Ba s allons <br /> Thickest Thinnest atgs Thickest Thinnest geegs BentonitelCement Mix 3%1.1.41 s°/a2 41 <br /> 10 1 Bentonite per 47 Ind 2 82 4 7 <br /> 2.5 5 1 5 2 Bentonite per 94 Ind <br /> 5 10 2 10 zo <br /> 10 20 15 3 15 <br /> 4 20 40 4 <br /> 25 50 5 <br /> 11 5 25 5 6 <br /> 6 30 <br /> 60 <br /> 1755 35 7 35 TO 7 <br /> 20 1 40 1 <br /> 40 30 B 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />