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AN JOA10UH tio",,�.aa')Jt'lGi+. -."i <br /> -CCD LJ -- <br /> T Y ---- <br /> Monitorirtg We'lly'Soil Boring 1rispection Reporl, <br /> C <br /> Dale: 11 Inspector: CVAO cord!STRIKTi <br /> Facility Address: DOAj S. IlAdf,10M AVE <br /> Is it <br /> Well Address: ToLal Depth: <br /> WPB ODMO-L' Well#: Drilling Rig Type: <br /> Soil Boring#: "\ [Nilin 2" Annular END Seal Verified: 11 Yes IIIN:) <br /> Drilling Company: W4Iwaw M Screen Length Frdm� To: <br /> Driller Onsite: KIM 1404k"� <br /> Consultant: Filter Pacl< From: To: <br /> Geologist Bentonite From: To: <br /> r'roUL -orn: <br /> Fi To: <br /> Public VV ate r Sys t e rn Onsite: 1:1 Yes DNo ' . <br /> IN i P I-E T I Of r,41 0 SLove Pipe OChris <br /> Lie Bo <br /> Doi-nestic'\Nel I Onsite: 11 Yes DNo <br /> __1 C_s- <br /> ll yes, location and distance: <br /> N, <br /> SAMPLING <br /> 1-11olding Ternperat-Ure: <br /> Method: <br /> Screening miethod: <br /> Verified Chain Of CLIStOdy: 0 Yes DNo <br /> SPOH S =Z: <br /> Comannination Noted: 11 Yes EI N o <br /> 11 yes,spoils storage Location: <br /> Covered: EEc <br /> Ifyes, material: <br /> GROUTINIG or DESTRUCT ION Total Depth: Avw IIAk cy-wo <br /> 'h L <br /> Depth o Vklater <br /> Grout IN/laterial: V09LOV CtIREM41, T <br /> Gallons of Grout Used: O-S CA- Casing Type: <br /> OWell Installation D1&/ell Destruction Blanl< Feet Screen Feet <br /> OBoring Installation &oring Destruction Slot Size: <br /> Bags of Cement. <br /> POE T!-i0.% U 5 ED Bags Sand/Gravel: <br /> Tv <br /> Or'ressure Grout- ElOver Drill ,pe/Band ol Bentonite: <br /> Filter Pacl<Typej,'Si-,e: <br /> 01 Gravity OT remie 110.1[her Type of klethod: <br /> Cement":?Ib CRmEnt 9A113 <br /> Thickest Thinnest N&E-St <br /> T! <br /> 7•j J <br /> 5 1 10 1 IBert"L'onilba per 417 lb 2.471 <br /> 5 j .10 = 10 I -10f-lionite I lb <br /> 1-5 15 30 'i R e R per Iq 2.821 A <br /> L)_1 e I 2'G I -90 41 <br /> 15 1 .0 6 so I 60 I 6 <br /> S3 7 25 '.0 <br /> F 40 1 m I 0 <br /> 10/16;/2017 <br /> 18EiF3 E.Hazeitori Avenue Stockton, Californlia 35205 J T 206 4,68..3420 I F 209 4.64-0138 1 www.sicelId.com <br />