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� 8N |O8DHlN <br /> ��N�WU��gW|kV Environmental Health Department <br /> � —�COUNTY-- <br /> G/azmuogrows here. <br /> Monitorin VVeU/SO'| Boring Inspection Report <br /> Date: Iiispector: CONSTRUCTION <br /> Faoxtypmorcsu' <br /> Well Address: Total Depth: <br /> /\ Drilling Rig Type: <br /> ��� �` <br /> ~~' ~~'^'�^ Min Z"Annular EHD Seal Verified: [] Yes []No <br /> Drilling Company: <br /> Screen Length From: To: <br /> Driller �------ '----------- <br /> Fi|terPook From: To:Consultant: 'W\j __________ <br /> Bontonita From: To: <br /> Geologist: ------- '----------- <br /> - Grout From: To' <br /> .-------- �-_-__-_--' <br /> m/ <br /> Public VVaterSysteroOnsite: 4u Yes []No {I}0JgqJBTION [] Stove Pipe []ChhotieBox <br /> Domestic Well Onsite: [] Yes QqNo casing <br /> . . <br /> If yes, location and distance: hmLgut . <br /> SAMPLING <br /> Holding Temperature: wvwrLe`"^isi cxWPuEMN <br /> ���oW� <br /> Method: <br /> Screening Method: EPY, grout <br /> Verified Chain of Custody: []Yes []No <br /> SPOILSlit x <br /> 9 - <br /> Contam|nadon Noted: []Yes PNo � <br /> |f yes, spoils storage Location: <br /> Covered: [] Yeu [�No : <br /> 7- 9-f P—% <br /> |f yes, material: <br /> GROUTING or DESTRUCTION <br /> Total Depth:Depth to Water: <br /> . <br /> Grout Material:— MATERIALS/IDEVIELOPMENT <br /> Gallons of Grout-- Used: Casing Type: <br /> []Well Installation �Well�D��rudinn Blank Feet ScreunFeet <br /> -_----__- <br /> Slot Size: <br /> []Dohn8 Installation LJ8ohngDestruction Bags of Cement: <br /> METHOD USED 8a8sSand/Grave|: <br /> Type/Brand ofBentonha: <br /> El Pressure Grout Filter Pack Type/Siza: <br /> El Gravity Tremie "4Othen Type ofMethod:water cement 47 lb Water Cement 941b <br /> gall s Bags gall s Bags <br /> Thickest Thinnest Bags Thickest Thinnest #Bag5 Bentonite/Cement Mix 3%Mix 5%Mix <br /> 10/16/2017 <br /> 1888E. Haza|ton Avenue | Stockton, California 852O5 | T 209468'34201 F 209464'0138 1 <br />