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1-4 <br /> C CSU T Y-- <br /> Allionibori-ng We-Ii/Soil Boring inspection Report- <br /> Date: II Inspector: C04 C Or--.'S-'V R U C T..t'O <br /> Facility Address: MC-HoRl 4% <br /> -Well Address: Total Depth: <br /> WP_# rjoAIWL- Well-#: Drilling Rig Type: <br /> soil Borino;-3 Drilling Company: Ov6V" Min 2" Annular EHD Seal Verified: 0 Yes 'F-Ii'\jo Driller Onsite: IXM Ilw90*vj Screen Length Frdni: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Offsite: 1:1 Yes ONO COINIPLETION El Stove Pipe ElChristie Box <br /> '1 <br /> I <br /> Domestic Well Onsite: 01 e s EINo <br /> 11 yes, location and distance: n4- <br /> IF <br /> A <br /> ':P <br /> SAMPLING <br /> Holding Teniperat-ure, <br /> Method: <br /> Screening I'VIethod: <br /> J V'A <br /> Verified Chain of Custody: ❑1:1 Yes EjNo <br /> SPOILS <br /> Contamination Noted: El Yes EI No <br /> It yes;spoils storage Location: <br /> 1 8 <br /> E�J <br /> Covered: 0 Yes ONo <br /> 1'16 =---4 -.11 wnwo�.' <br /> If Yes, material: <br /> GROUTINIG or DES TRUCTION Total Depth: <br /> Depth to Water: <br /> Grout Material: IW(VV9 0OW04 *Z, E IT <br /> Gallons of Grout Used: 'L Q%, <br /> Casing Type: <br /> EIVVell Installation EA/ell Destruction Blank _Fee T Screen Feet <br /> ElSoring Installation �4'Doring Destruction SIOTI Size: <br /> Bags ofiCernent": <br /> M E T H C-1 D U SE D Bags Sand./Gravel: <br /> L❑__IPi Type/Brand of Bentonjit": <br /> r-essure Graut 11 Over Drill Filter Pack Type"size: <br /> 0 Gravity F- nI,1-rp Type of Method: <br /> I - ie 1:10ther: <br /> ,;tier canlemi I b VV EI C�rnant 941h <br /> R:.!0.ts <br /> J; <br /> 0 B Pg <br /> licke nnEst B�S� Tnicl�. re-_nt_,"nitia;*.k M62 <br /> T! -t Thinn_. i I I eg Ti-lnn�_5�' 1 1 <br /> 2.5 5 5 1 19 1 1 jr_Cq,',01jH,.- j�L7 <br /> �L 1ID <br /> 10 <br /> _FP-,entcinilte pia-ir�,4 Ib 2.82 <br /> 15 3 1 15 1 30 1 '3 <br /> GI 20 4as110 <br /> 12.5 I ='S 5 <br /> so <br /> 17.5 I 35 I 7 I 35 70 <br /> J <br /> 1G/.1 6112 017 <br /> '868 'azalor,Averue fRockton, California 9522 J T 209 488-34120i V. 209 464-0136 1 �mv�si,caL-O corn <br />