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SAN JOAQUIN —COUNTY— ;�r` Greotness grows he, Public Water System Onsite Environmental Health Department Boring Inspection Report CONSTRUCTION Total Depth: Drilling Rig Type: Min 2" Annular EHD Seal Verified Screen Length Filter Pack Bentonite Grout From: From: From: From: ❑ Yes E] No COMPLETION ❑ Stove Pipe Domestic Well Onsite: ❑ Yes El No If yes, location and distance: SAMPLING Holding Temperature: Method: Screening Method: Verified Chain of Custody: ❑ Yes El No SPOILS Contamination Noted: ❑ Yes ❑No If yes, spoils storage Location: Covered: ❑ Yes ❑ No If yes, material: rr GROUTING or DESTRUCTION Total Depth: 20 0 Depth to Water: I Grout Material: Gallons of Grout Used: L II a Well Installation ❑Well Destruction ❑Boring Installation ❑Boring Destruction �r,>t�reri.�tr«aa ❑Pressure Grout Clover Drill ❑ Gravity fgTremie ❑Other: Water allons Monitoring Well/Soi Q ( , Date: 6 / Inspector: �O" I \ ' Facility Address: 3-.222 S �l Well Address: 1 WP# d0 3 Well#: f Soil Boring#: 2 Drilling Company: CQ. &l.04 O" ✓t L Driller Onsite: Consultant: 3 Geologist: 4 Public Water System Onsite Environmental Health Department Boring Inspection Report CONSTRUCTION Total Depth: Drilling Rig Type: Min 2" Annular EHD Seal Verified Screen Length Filter Pack Bentonite Grout From: From: From: From: ❑ Yes E] No COMPLETION ❑ Stove Pipe Domestic Well Onsite: ❑ Yes El No If yes, location and distance: SAMPLING Holding Temperature: Method: Screening Method: Verified Chain of Custody: ❑ Yes El No SPOILS Contamination Noted: ❑ Yes ❑No If yes, spoils storage Location: Covered: ❑ Yes ❑ No If yes, material: rr GROUTING or DESTRUCTION Total Depth: 20 0 Depth to Water: I Grout Material: Gallons of Grout Used: L II a Well Installation ❑Well Destruction ❑Boring Installation ❑Boring Destruction �r,>t�reri.�tr«aa ❑Pressure Grout Clover Drill ❑ Gravity fgTremie ❑Other: Water allons Cement 471b Bas Water gallons Cement 941b Bags Thickest Thinnest 1: Bags Thickest Thinnest .Bags 2.5 5 1 5 10 1 5 10 2 10 20 2 7.5 15 3 15 30 3 10 20 4 20 40 4 12.5 25 5 25 50 5 15 30 6 30 60 6 17.5 35 7 35 70 7 20 40 8 40 80 8 ❑ Yes ❑No To: To: To: To: ❑Christie Box casing height —EWT 1.SC'VE-GRCXJND CC &V LEr{oN Ct-i:ST C:'*1PI,=-nCNFTICN Ground Surface proof n. n. alcrtod = 3 ancon = gT w pack 4 n. Ir= n. MATERIALS/DEVELOPMENT Casing Type: Blank Feet Slot Size: Bags of Cement: Bags Sand/Gravel: Type/Brand of Bentonite: _ Filter Pack Type/Size: Type of Method: Screen Feet Bentonite/Cennent Mix 3% Mix 5% Mix Bentonite per 47 Ib 1.41 2.47 Bentonite per 94 Ib 2.82 4.7 yb.~f ( So ld)�7f I"Mk- 3 s C o 10/16/2017 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.socehd.com