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a S A N <br /> C 0 U N TY------ <br /> I 0,-'._ti11 �1,1 n" !VV e,1 S C,i I B o.r i ri g II s t�.To n Re o.r L. <br /> Date: Inspector: CAP C 0 r"I ST R u(7 10 <br /> Facility Address: IWA3 5, 044"1 Mk <br /> Weil Addre5s: Total Depth: <br /> WP OQIAAIjb- Well: Drilling Rig Type: <br /> Soil Boringi#: I Jilin 2" Annular EHD Seal Verified: 11 Yes D IN o <br /> Drilling Company: W&OkD 40 Screen Length Frcim� To: <br /> Driller Onside: KM LIOOCF(tJ <br /> COnSLIli.3IIt: Filter Pack From: To: <br /> Geologist: Bentonite Irl'0111:_ To: <br /> Grout From: To: <br /> Public Water Sys em Onsite: 1:1 Yes ONO .001 -NIPLETION El Stove Pipe OChristie Box. <br /> Domestic Well Onsite: LI Yes ONo <br /> 11 ve-s., location and distance: <br /> Z' <br /> Q, 7k'� <br /> SAMPLING <br /> HI ul I d i n g T e'n p e r a IDU r e:_ <br /> Sur ac'. ­­ <br /> m et.h o Cl: <br /> i <br /> Screening Mlethod: ..E.L <br /> Verified Chain Of Custody: 0 Yes ONo <br /> Spoil S <br /> Contamination Noted: El Yes EI No <br /> ' <br /> IT yes; spoils storage 1 ocation: <br /> Covered: ❑ Yes <br /> nna'Leri@i: <br /> GROUTING or DFST RUUICT ION Total Depth: <br /> D e pLih 'Lo Vkiater <br /> Grout IVI a'L e r i a 1: fQ'FOO Ockftf'T t <br /> I TE RL A.L S/D,E V EE L P NPI E N! <br /> T <br /> 7 U s e d: 1 60- <br /> C-,zillons of Grout Casing Type: <br /> OV'vIEll Installation DWell Destruction Blank—Feet Screer Fee- <br /> Slot <br /> Installation 56Boring Destruction Slo''Size: <br /> Bags of Cement: <br /> %JE—HeD USED Salto'/Gravel: <br /> D <br /> . i Bags Sand./Gi <br /> OPressure Grout ElOver Drill TvlDe/Srand of Bentonite: <br /> Filter Pacle Type/Size: <br /> D Gravity r_—_:)T r e III i e El 0 the r: Type of Method: <br /> Carnent 4711 Cement 9411) <br /> Thickes, Thinna"t-I <br /> T! <br /> 5 10 c.n o i i'I G Pei-41L 7 11) I.zl. 2AIr 7i. <br /> 170 �OPe n o n e r.91 4 1 b 2.821 4.7 <br /> 15 30 j— <br /> '0 I 20Or <br /> 4 <br /> 5 5 5 1 3 25 1 50 1 5 <br /> so I 60 I 6 <br /> 70 <br /> 35 7 <br /> i 0 6 -41 7 <br /> 1668 E. Vazeton Avenue Stockton,Cafifoma 9520.--j T 200 4-68-.3420 J F 249 4,64-0138 www.sicohd.com <br />