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SAN JOAQUIN Environmental Health Department <br /> ----COUNTY------- <br /> Greatness grows here. <br /> �j Monitoring W� ell/Soil Boring Inspection Report <br /> Date: (� Inspector: I a-,��D� r7/ . CONSTRUCTION <br /> Facility Address: <br /> Well Address: 110 VOI-) V N Total Depth: <br /> WP#0,939yL/ Well#: a Drilling Rig Type: <br /> Soil Boring#: <br /> y Min 2"Annular EHD Seal Verified: El Yes El No <br /> Drilling Company: D r �;Iti <br /> Driller Onsite: / Screen Length From: To: <br /> Consultant: WEI '70 on oKi'�a l Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: CO�"PLETION EnoN <br /> Method: Ground Surface' + <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No <br /> tt. <br /> it. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: slo"d <br /> section _ <br /> Covered: ❑ Yes ❑No =' <br /> ons pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: 4. =_ <br /> Depth to Water: lilt fL — --ft. <br /> GroutMaterial: &0` e_wg--o MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: S <br /> Casing Type: <br /> Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑BSlot Size: <br /> oring Destruction Bags Size: <br /> Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Ceme 4711 Water Cement 941b <br /> allons Bas 9.011 ons Bags <br /> Thickest Thinnest RBags Thickest Thinnest VBags Bentonite/Cement Mix 3%Mix 5%Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 10 2 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 8 <br /> 6 10/16/2017 <br /> 1868 E. Hazelton Avenue"I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s4cehd.com <br />