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' <br /> - <br /> ��Pj ���,UP <br /> ^ ��DYf ���K������ {�����''/ --��� ^ e.[I' -- �0UNTY--- — ^ ~' ' <br /> ^ oaZ. <br />^ <br /> Monitoring Well/Soil AOr'Dg |DSDe[ƒ'OD Report <br /> Facility Address: &�)c <br /> Well aoo Tota| Depth:______ <br /> Vv Drilling Rig Type: <br /> Soil,Borin- Min 2.Annu|arEHDSea]Verified: [] Yes []No <br /> Driller Onsite: Screen Length From: To:— <br /> Consultant: Filter Pack From:— To:_________ <br /> Geologist: Bentonite . From: To:_________ <br /> Grout From: To:— <br /> Public Water System <br /> o:________Pub|icVVater5ystem Onsite:� [] Yes []No <br /> <I�M9LETK]0! [] Stovepipe []Christie8ux <br /> Domestic Well Onsite: [] Yes []No <br /> =as�na <br /> |fyes, location and distance: <br /> Su&NqJYG ���/ a�� `�rx� 8*11--i'~ <br /> Holding Temperature: <br /> ��upizrmm c�ne��sox <br /> � <br /> Method: <br /> Screening Method: FA <br /> VIA <br /> Verified Chain of Custody: [] Yes []No <br /> - <br /> SPOILS <br /> Contamination Noted: [] Yes []No s <br /> |fyes, spoils storage Location: > � <br /> a= <br /> � | <br /> Covered: L] Yes []No -- / <br /> |fyes material: <br /> GROUTING or DESTRUCTION |ota| ueptx::iw | <br /> Depth -----� -�---E����� ' <br /> Grout Material: <br /> Gallons ofGrout Used: <br /> Casing Type: <br /> LJVVeU |nstaUadon []VVe| Destruction Blank Feet Screen Feet <br /> � <br /> LJBohng|ns�'Uad � <br /> Installation Destruction Slot Size: <br /> on <br /> Bags ofCement: <br /> METHOD USED BaQs5and/Grave|: <br /> []Pressure 600ut []OverDril| Type/Brand ofBentonite�� <br /> Filter PackType/Size� <br /> [] Gravity []Tremie []Other: Type ofK4ethud: <br /> �Is Bags <br /> Thickest Thinnest 4 B'�gs Thickest Thinnest Bags S'Smtenitelc"ernent Nfix 3% mix 15% mix <br /> io UI__ 10 20 Benfoniteper!94lb 2.2 4.7 <br /> 13 io <br /> �\` —� <br /> -vz"»^^�. 7L" <br /> 1O/16/2O17 <br /> 18O8EHazelton Avenue I Stockton, California A52O5T %O0488-342O1 F 209 464-0138 <br />