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<; SANJOAQUIN Environmental Health Department <br /> —COUNTY— <br /> G1 ness grows here. <br /> Ionito ' Well/Soil Boring Inspection Report <br /> Date: `AI-) 1l Inspector: CONSTRUCTION <br /> Facility Address: <br /> Well Address: yc"-s Total Depth: <br /> WP# Well#:�l`,f� Drilling Rig Type: <br /> Soil Boring#: Z <br /> Min 2"Annular EHD Seal Verified: ❑ Yes []No <br /> Drilling Company: <br /> Driller Onsite: �w �. Screen Length From: To: <br /> Consultant:�� �5-s��Q � r✓ Filt Pack From: To: <br /> Geologist: ��,��-t , *An <br /> �� ite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: f� Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ONo casing <br /> If yes, location and distance: height <br /> -EWT <br /> SAMPLING ABavE-GROUND <br /> Holding Temperature: COLET10N C4-1A t�F' <br /> Method: around Staiacs '— <br /> Screening Method: 01� Qf°ut <br /> Verified Chain of Custody: ❑ Yes ❑No <br /> fi. <br /> fi. <br /> SPOILS <br /> Contamination Noted: ❑ Yes /No <br /> If yes,spoils storage Location: slonad = <br /> Covered: ❑ Yes ❑No :w = <br /> _ g—f yam <br /> If yes, material: . <br /> GROUTING or DESTRUCTION Total Depth: ( , <br /> Depth to Water: 2F�1 n• <br /> Grout Material: Air � � <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation �Boring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> allons Bas Rall ons Bags <br /> Thick n I Thinnest 3t B. Thickest Thinnest #Bags BentonitefCement Mix 3% Mix 5% Mix <br /> 5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 10 10 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 7.5 15 3 15 30 3 <br /> 10 20 4 20 40 4 <br /> 12,5 25 5 25 50 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 1 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 1 www.s'cehd.com <br />