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AN I 'MIN <br /> if <br /> -.1-c -wne ["L! .,.,,1,''1,. II ,f3 <br /> CC -INTY------ <br /> 1C------ <br /> on,I to.n'1-1 g ` Y(=-1 /So c..i1 Boring in-s-peCtion R e p ort <br /> Date: Inspector: CM' CONS TRUCT P NI <br /> ----E <br /> Facil ty Address: MOM S. M4490 A\ <br /> -Well Address. Total Depth: <br /> Wp-.4OQ\ 001 <br /> ' - <br /> J� <br /> Tr Well: Drilling Rig Type: <br /> Soil Boringff': 0%• Drilling Company: AMA% 6V ib/lin 2" Annular END Seal Verified: 0 Yes El Nj o <br /> Screen Length Front: To: <br /> Driller Onsite: UVD(MS"j <br /> Consultant: Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> I <br /> Grout From: To: <br /> Public Water Sys.-ern Onsite: L1 Yes D N o DIV'!P LETI ON D Stove Pipe ElChristie Box <br /> Domin-stic We 10 isite: 0 Yes EJNo <br /> 11 yes, location and distance: <br /> SAMPLING <br /> Hiolding Terrnpera'Dure:_ <br /> Me-d-od: <br /> Screening MIz-:-.-hod: <br /> Verified Chain of Custody: ❑ Yes 01,40 <br /> SPOILS <br /> Contamination Noted: D Yes E)No <br /> Ii yes,spo;ls storage Location: <br /> J <br /> Covered: 0 Yes ❑IDN o <br /> wL, <br /> L i <br /> vps, mate r: <br /> CROLTINIGo-DFSTRUCTION TotalDep th: <br /> Dep-& to \A./2ter: <br /> &OU'L IN/laikeria : F09WO UW 4VI, 'Af A%T E.R f A L S/LD,rE V E L--.'3 P NP,E N T <br /> Gallons off G.J--D AL U s e dt: Casing Type: <br /> EhVell Installation DA/ell Destruction Blank Feet Screen Feet <br /> 013oring Installation Y}Soring Destruction SIO'L Si7e: <br /> Bags of Cement: <br /> 'nAl E H C.D USE,D <br /> Bags Sarld./Gravel: <br /> L7-Pressure Grout 00ver Drill Type/Brand of Bentonite: <br /> Filter Pack Type./Size: <br /> EI Gravity E—1 r-e m I e El ot h e r: Type of Method: <br /> „tier I c2rnanl Ib VV?. C2mcnt 94113 <br /> cllUnsBags Rallons <br /> T"id F <br /> h Thmn=-51 S.G I F6 Felcen mvE ikfix Mcm. :04 .4 <br /> 2.5 I i17 'Brar-lionite paw/,IL7 111) 1.-1(1 2.-,!7 <br /> 10 -,0 i;L-e p e r 4 Ib 1 2.821 4.71 <br /> 3 II 15 I 20 1 -3 <br /> L) I 4 is I 40 <br /> 25 50 1 5 <br /> 60 6 <br /> 55 I 7 ;5 <br /> ---if <br /> 0/161' 1017 <br /> Hazeilor,Avenue Stockton: GaVornila 9520,) I T 200 468--3420 J F 209 4,64-0138 1 %mv.sicehd.cpm <br />