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SAN .,JOAQUIN Environmental Health Department <br />—COUNTY— <br /><t Grea! ess groves here. <br />frrrl q- cin 1A, ung Well/Soil Boring Inspection Report <br />Date: 0 1 �- Inspector: V `' CONSTRUCTION <br />Premise Addre6s: �ry�� <br />WP#: _ Total DepthType: : (Q CC //%% <br />Well#: T� Drilling Rig 86 4vJ 5--bVv–, <br />Soil Boring#: Min 2" Annular Seal Verified: El Yes E]No <br />Drilling Company: l �iU �'�f .G' <br />Driller Onsite: M a Screen gth From: To: <br />Fil ack From: To: 1 7q0 <br />Consultant: <br />Geologist: <br />S G out From: To:5 <br />Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br />Domestic Well Onsite: ❑ Yes ❑No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method:_ <br />Verified Chain of Custody: <br />canal c <br />Contamination Noted <br />If yes, spoils storage Location: <br />Covered: <br />❑ Yes ❑No <br />❑ Yes ❑No <br />❑ Yes ❑No <br />If yes, material: o� <br />GROUTINd or DESTRUCTION Total Depth: Z lv <br />Deptka-t� Water: S <br />Grout Material: <br />Gallons of Grout Used: r <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation ❑Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity remie ❑Other: <br />Water <br />gallons <br />Cement 47 lb <br />Bag's <br />Water <br />gallons <br />Cement 941b <br />Begs <br />Thickest Thinnest <br />IBags <br />Thickest Thinnest <br />PBags <br />2.5 <br />5 <br />1 <br />5 <br />10 <br />1 <br />5 <br />10 <br />2 <br />10 <br />20 <br />2 <br />7.5 <br />15 <br />3 <br />15 <br />30 <br />3 <br />10 <br />20 <br />4 <br />20 <br />40 <br />4 <br />12.5 <br />25 <br />5 <br />25 <br />50 <br />5 <br />15 <br />30 <br />6 <br />30 <br />60 <br />6 <br />17.5 <br />35 <br />7 <br />35 <br />70 <br />7 <br />20 <br />40 <br />8 <br />40 <br />80 <br />8 <br />casing <br />height <br />ABOVE-GROUNO C}�R15i 1' iiOX <br />COh LETION COMP f7jQN <br />Ground su facs <br />grout tri.3 < <br />24O <br />n. <br />r — V <br />slottai <br />sac'on <br />M <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank Feet <br />Slot Size: <br />Bags of Cement: <br />Bags Sand/Gravel: <br />Type/Brand of Bentonite: <br />Filter Pack Type/Size: <br />Type of Method: <br />Screen Feet <br />BentonitelCement Mix 3% Mix 5% Mix _ <br />Bentonite per 47 Ib 1.411 2.47 <br />Bentonite per 94 Ib 2.821 4.7 <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.sjcehd.com <br />