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V;���������� i�����'l �������r���� <br /> ^ -- COUNTY— —-- � '- ' ^ �'' ~ <br /> [Monitoring Well/Soil Boring Inspection Report <br /> Date., Inspect r: C" �cv CONSTRUCTION <br /> Facility Address: <br /> (2 d��Ave <br /> Well Address: Total Depth:_______ <br /> Vv Drilling Rig Type: <br /> Soil - Min 2^Annular EHDSea]Verified: [] Yes []No <br /> ' Screen Length From: To: <br /> D."= "..^.`= `---_-_' �-_-__---_ <br /> - Filter From T <br /> Consultant: � »:________ <br /> Geologist: Bentonite From:______ To:— <br /> Grout From: To:__________ <br /> Public Water System Onsite:� LJ Yes []No <br /> {I}M�`LETK}N [] Stovepipe []Ch/istieDox <br /> Domestic Well Onsite: [] Yes []No <br /> c^s2_zg <br /> |fyes, location and distance: <br /> SAYUqJNf� <br /> Holding Temperature:� oou�Lcrxzw cnn�sr�aox <br /> coapuE11ow <br /> Method: e,Cyjcusv��= <br /> Screening Method: <br /> Verified Chain ofCustody: [] Yes []NoN\ e, <br /> .. <br /> SPOILS <br /> Contamination Noted: [] Yes []No � <br /> |fyes, spoils storage Location: <br /> Covered: [] Yes []No / <br /> |fyes, material: <br /> GROUTING or DESTRUCTION Total Depth: / <br /> Depth <br /> Grout Materiak. <br /> Gallons ofGrout Used: <br /> Casing Type: <br /> LJVVe|| Installation LJVVe|/ Destruction B|ank ___Feet Screen Feet � <br /> 5kring <br /> []Boring|nsta||ation axuuringDes1ruction <br /> Bags ofCement: <br /> METHOD USED 8agsSand/Grave|: <br /> Type/Brand ufBentonite� <br /> � <br /> []PressureGrout []DverDrU| <br /> Filter Pack Type/Size: <br /> [] Gravity []Tremie []Other: Type of Method: <br /> < �2 10 20 2 Bentonife per 94 lb 2.E <br /> 10 20 A 20 40 4 <br /> 12.5 i5 25 50 5 <br /> 40 40 6-0 _� � �� . <br /> �^\0�rvt <br /> �o <br /> - -' � 10/16/2017 <br /> 18S8E. Hazelton Avenue Stockton, Cu|iforniaA52O51 T 200468'34201 F 209 464-0138 1 <br />