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SANJOAQUIN Environmental Health Department � UII"- —COUNTY--_ Greotness grows here. Mon' i'tJoring Well/Soil Boring Inspection Report Date: C7 �� Inspector: r CONSTRUCTION Facility Address: b b (,f/ arttc K WOW Well Address: Total Depth: WP# Well#: Drilling Rig Type: Soil Boring#: r Min 2"Annular EHD Seal Verified: ❑ Yes El No Drilling Company: Screen Length From: To: Driller Onsite: Consultant: Filter Pack From: To: GeologiBentonite From: To: Grout From: To: Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes ❑No casing If yes, location and distance: WT height SAMPLING ABOVE-GROUND Holding Temperature: COLPLET10N COMPLETION Method: Ground Surfaos Screening Method: orou< Verified Chain of Custody: ❑ Yes El No tt. tt. SPOILS Ft \ 0 Contamination Noted: ❑ Yes El No I C If yes,spoils storage Location: _ ,C-- atoned Z on Covered: ❑ Yes ❑No t-i 0 p—S,Pads If yes, material: p _ Li- 5 GROUTING or DESTRUCTION Total Depth: G-Hb 1 L _ ,1— a Depth to Water: ^ 62 Grout Material: MATERIALS/DEVELOPMENT Gallons of Grout Used: Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet ❑Boring Installation_�*oring Destruction Slot Size: Bags of Cement: METHOD USED Bags Sand/Gravel: Type/Brand of Bentonite: ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: Gravity ITremie ❑Other: Type of Method: Water Cement 471b Water ment 94lb allons Bas allons Bags Thickest Thinnest bBags Thickest Thinnest s Bentonite/Cement Mix 3%Mix 3%Mix 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 5 10 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 7.5 15 3 15 30 3 � , r 10 20 4 20 40 4 O � ,�j � (� 12.5 25 5 25 50 5is 30 6 30 60 Jc& 17.5 3520 40 a 35 0 s I�, c5 �_ 1 W V 446/2017 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209464-0138 1 www.s6cehd.com