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� 8N |M8�N|N <br /> , ^ J��|V �WM�W||V Environmental Health D ���n�e0t <br /> ---[[}UNTY--- Department <br /> Greotnev, ym** here. <br /> MODf0['DgVVeU /S0U Boring Inspection Report <br /> SLl <br /> ..^..^'....^~~ . <br /> Well Address- ~---~ Total Depth: 70o <br /> «v U��~____ Drilling Rig Type: <br /> Soi| 8oring#: �^*�- <br /> Drilling K0inZ^Annu1arEHD3ea|Veh�ed� ��,== []Nu <br /> Dri||erOnsite: Screen Length Fnonn� Tu:_________ <br /> Consultant: -----' �—��—����---------- Filter Pack Fnonm� To:___�_____ <br /> Geologist: --- Bentonite From: To: <br /> Grout From: 20py__ To: C^— <br /> Pub|icVVaterSystennOnxite' El []No <br /> ' COMPLETION []Stove Pipe []ChhstieBox <br /> Domestic Well Onsite: ' [] Yes []No <br /> casing . <br /> If yes, location and distance: height ' <br /> SAMPLING Aazvs-Gnoamo <br /> cmn~~^ <br /> Holding Temperature: oowpu�'�ow <br /> COMPLETiON <br /> Method: cmouramLwmc* <br /> Screening Method: grow <br /> Verified Chain of Custody: L1 Yes []No <br /> SPOILS <br /> Contamination Noted: [] Yes F]No <br /> /fyes,spoils storage Location: l `� <br /> *�m� = <br /> � | <br /> Covered: [] Yes []Nogrx�w Pack <br /> -- � <br /> |fyes, material: <br /> GROUTING or DESTRUCTION Totail Depth: 0 Lf <br /> Gallons of Grout Used: b-q3 UL7 th� Casing Type: <br /> >1�e|| /nsca||anon E]vve|| uestructmn Blank Feet Screen Feet <br /> Slot Size: <br /> []BuringInstallation LJBo/ingDestruction <br /> Bags ufCement: <br /> METHOD USED Bo8sSond/Grave|: <br /> []PressureGrout []UverDri|/ Type/Brand ofBentonite: <br /> Filter Pack Type/3ize: <br /> [] Gravity KTremie []Other: Type ofMethod: <br /> Water Cement 47 1b Water Cement 94 lb <br /> eallons Bags gallons Ba S - <br /> Thickest Thinnest 9 Bags Thickest— Thinnest Bags Bentonite/Cement Mix 3% Mix 5% M <br /> 10 20 4 20 40 4 <br /> ' <br /> 1O/l6/2O17 <br /> 185OEHazelton Avenue Stockton, California 052O5T 200488'342O / IF 209 464-0138 / <br />