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' <br /> �& � ��&��U� <br /> ^J���������y0 �� ^�������� ������ ��� <br /> ' ---c[>UNTY--- ---'' Health -- <br /> h� <br /> �, o�neo 9m"x �,n` - <br /> ' � <br /> K8on'fOr'Dg8UeU/SO'| Boring Inspection Report <br /> Date. inspector:AmM6 CONSTRUCTION <br /> Well Address: - Total Depth:_+^10_ <br /> WP# Well#: Drilling Rig Type: <br /> Soil 8ohng# <br /> ' Min Z"Annular EHDSea[Verified: El Yes []Nu <br /> Drilling Company: <br /> �---------- Screen Length From: To: <br /> Driller Onsite: <br /> `------- �--------- <br /> Filter Pack From: To: <br /> Consultant: U\kM �-------' <br /> Geologist: 'Bentonite From��Z0�--- To: -10\0--__ <br /> Grout From: To: <br /> 4-t- dO-Wy\ <br /> Public Water System Onsite El Yes []No COMPLETION [] Stove Pipe OChristie Box ' <br /> Domestic Well Onsite: [] Yes []No casing <br /> |fyes, location and distance: h=lsut <br /> SAMPLING o <br /> Holding Temperature: COWuETvOm COMPLETiON <br /> amumuoun=� <br /> Method: <br /> Screening Method: n- grout <br /> VZ ft. <br /> Verified Chain ufCustody: [] Yes []No <br /> SPOILS / <br /> � <br /> Contamination Noted: El Yes []No ~ <br /> |fyes,spoils storage Location: alonad <br /> Covered: []Yes []No g-vw Pack� <br /> |fyes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> (j �f <br /> Depth toWater: -----~r� -�---ur�=m�� <br /> Grout Material: <br /> � MATERIALVIDEVE LO PM ENT <br /> Gallons ofGrout Used: ' n <br /> Casing Type: <br /> t��``/el| Installation []VVe|| Destruction Blank Feet Screen Feet <br /> '~< --------- --------- <br /> Slot Size: <br /> []BoringInstallation LJBohngDestruction Bags ofCement: <br /> METHOD USED Bu8sSand/Grave|: <br /> Type/Brandof8entonite� <br /> OPr�sueGm� OOverDriU <br /> Filter Pack Type/Size: <br /> [] Gravity �-emie []Other: Type�� <br /> ' <br /> Water Ce!me:n�t47�lb Water Cement 94 lb <br /> eallons Ba 5 gallons Bags <br /> Thickest Thinnest 9 Bags Thickest Thinne5t n Bags Bentonite/Cement Mix 13% Mix 5% Mix <br /> 5 10 1 2 10 20 2 Bentonite per 94 Ib 2.821 4.7 <br /> 10 20 4 20 40 4 <br /> 15 30 6 30 60 4't '0 <br /> ~- 1 <br /> lO/l6/2017 <br /> 1808E. Hazelton Avenue) Stockton, California 952U51 T 20Q468-342U1 F 209 464-0138 1 <br />