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SAN <br /> JOAQVIIN <br /> 'a <br /> COUNITY------- <br /> N/lon'l-todrig wdl/mljoil Bc if ig inSpect ,nn Repov- <br /> Date: 1111[J-1. Inspector: OP C0 NST RU M PO[:l <br /> Facility Address: MOM 5. McHwW AVE <br /> Well Address: 11 ', . Total Depth: <br /> WP7'—Nmo Well#: Drilling Rig Type: <br /> Soil Boring'H: I- <br /> Drilling Company: AN40ED CO Min 2" Annular END Seal Verified: El Yes E]No <br /> Driller Onsite: LIVDCiI,� Screen Length Fr6i)i:_ To: <br /> Consultant: Fiber Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water Systern Onsite: El Yes 0 Njo 0 Stove Pipe 11Chris-Lie Box <br /> LEETIOf N <br /> Domestic Well Onsite: 0 Yes E]No <br /> 11 yes, location and clist2rice: 4n. <br /> SAMPLING <br /> 1-1olding Ternperat-Ure:_ <br /> Ml et 11-1 o d: <br /> , <br /> ScScreeningMlethod: C2 <br /> gmut <br /> Verified Chair l Of CLIstody: 0 Yes ONo <br /> P 0 1 LS <br /> Con-Lar-nination Noted: 'I-] Yes ONo <br /> 11yes,spoils storage Location: <br /> Covered: El Yes EIIN o <br /> It yes, material: <br /> GROUTHNIG or DFSTRUCTION Total Depth: <br /> Depth to Water: <br /> GiOUT I'Viaterial: WtoM C*M"N- <br /> Galloris of Grout Used: 'L CAL T <br /> Casing I ype: <br /> OV'Vell Installation OWell Destruction Blank Feet Screen—Feet <br /> Sluff Si2e: <br /> Destruction <br /> 013oring Installation Goring Bags Ci Cement: <br /> M E T H C.D US'D Bags Sand./Gravel: <br /> Tv -/ c <br /> Or"ressureGrout 110verDrill ,pp'Brand of Benwnite: <br /> Filter Pack Type/Size: <br /> 0' Gravity EIT ramie 00-ther: Type of Method: <br /> Cement 94I1; <br /> Ons <br /> Thi dt r.11 I TNn,,=-,'L B z3g, I _.I!i c k Es- <br /> lhinnc5ck'iix1' <br /> 2.5 5 I 5 I i0 I jBpe..4s H) '1.'4 2.-,"71 <br /> 5 1 10 I io I 20 <br /> I 7r-1-a a r.2,4 IL <br /> 1-5 I 3 I i5 30 <br /> 20 I 20 I 1 <br /> j I 110 <br /> 25 i _' -90 l 5 <br /> I 15 �30 6 so I 60 I 6 <br /> i7.5 I 35 I 7 35 I a I 7 <br /> -10 PO <br /> ,668 E. Htazeil-on Avenue Stockton: Galiforni'a 95205 T 200 468--3420 P 209 4,6-4-0-138 1 %vwwi.sicehdxcm <br />