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S A N:J O AQ U S N EnvironmerfL-) Health Department <br /> COUNTY— <br /> Greatness groves here. <br /> M/oniito`'rin_g` Well/Soil Boring Inspection Report <br /> Date: w t Inspector: CONSTRUCTION <br /> Facility Address: 5�. C�rrw1 <br /> Well Address: Total Depth: <br /> WP# 0031?tiL9 Well#:.7_Q Z Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: N <br /> Driller Onsite: Lo.t�...se. Screen Length From: To: <br /> Consultant: 0-winMu (tee ,.i.�- Filter Pack From: To: <br /> Geologist: CJA--1 S Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑Yes []No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: laaignb <br /> SAMPLING ABOVE-GROUND q �sryeox <br /> Holding Temperature: COWLETION coMPLETioN <br /> Method: ocouncl surra°�Screening Method:Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No #' <br /> ft. <br /> SPOILS <br /> e ' <br /> P <br /> Contamination Noted: ❑ Yes ❑No 0 <br /> If yes,spoils storage Location: elected =,• = 3 <br /> "Cion <br /> Covered: ❑ Yes []No — g, qP,ck <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: 20 1 <br /> Depth to Water: ° <br /> Grout Material: VN cdt- MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used:rl2S a <br /> Casing Type: <br /> ❑Well Installation HCVell Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> [I Boring Installation El Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout <br /> M ver Drill Filter Pack Type/Size: <br /> ElGravity 0' remie ❑Other: Type of Method: <br /> Water cement 471b Water Cern t941b <br /> allons ea s gallons Ba s _ <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% MIX 5%MIX <br /> 15 5 1 s 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 10 2 10 20 z lBentonite per 941b 2.82 4.7 <br /> 7.5 15 3 15 30 3 <br /> to 20 4 20 40 1 4 <br /> 12.5 25 5 25 5B 5 GbS g <br /> is 30 6 30 60 1 6 <br /> 17.5 35 7 35 70 1 7 �� �� �� S 20 40 8 40 80 8 b <br /> 10/16/2017 <br /> 1 y 116 5�'sS � <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />