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%/o 01 �pu'iN ( Environmental Health Department _� SAN�J0A0UIN \ ^{) —COUNTY- - ti��, �' Greatness grows herb Monitoring Well/Soil Boring Inspection Report Date: �2- Inspector: CONSTRUCTION Facility Address: 1 Q5 Well Address: L _q52_4 I Total Depth: WP# 00 `414C61 Well#: / Drilling Rig Type: Soil Boring#: B� Min 2"Annular EHD Seal Verified: ❑ Yes EJ No Drilling Company: `VQC'fo,,ev r Driller Onsite: n Screen Length From: To: Consultant: I� C' cp Filter Pack From: To: Geologist: Bentonite From: To: Grout From: To: Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes El No casing If yes, location and distance: WT height SAMPLING ABOVE-GROUND Holding Temperature: CONFLEr10N COMPLETION Method: Ground Surface Screening Method: grout Verified Chain of Custody: ❑ Yes ❑No �n• ft. ft. SPOILS =_ e Contamination Noted: ❑ Yes El No If yes, spoils storage Location: stood soon = B Covered: ❑ Yes El No _ g—+tack If yes, material: GROUTING or DESTRUCTION Total Depth: . Depth to Water: \-�b U�Vt.r n• — tt Grout Material: NC-lak u1' wr MATERIALS/DEVELOPMENT Gallons of Grout Used: Casing Type: ❑Well Installation ❑Well DestructionBlank Feet Screen Feet ❑ Slot Size: Boring Installation RBoring Destruction �� Bags Size: Cement: METHOD USED �� Bags Sand/Gravel: Type/Brand of Bentonite: ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: Gravity ❑Tremie ❑Other: Type of Method: Water Cement 471b Water Cement 941b allons Bas gallons Bags Thickest Thinnest uBags Thickest Thinnest It Bags Bentonite/Cement Mix 3% Mix 3% Mix 2.5 5 1 s 10 1 Bentonite per 47 Ib 1.41 2.47 s 10 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 7.5 15 3 15 30 3 10 20 4 20 40 4 12.5 15 5 25 50 5 15 30 6 30 60 6 17.5 35 7 35 70 7 20 40 8 40 80 8 10/16/2017 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.s*cehd.com