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N�� <br /> " -- [DUNTY--- <br /> Monitoring W6^N/SO'| Boring |OsDeCtiDD Aep{]Ff <br /> Facility Address:_ C ve <br /> Well AddTotal Depth: <br /> yv Drilling Rig Type: <br /> Soil - Min 2" Annular EHDSeal Verified: [] Yes []No <br /> � <br /> Screen Length FromTo: <br /> DrillerOnsite: From:- <br /> Consultant: Filter Pack From: To:_________ <br /> Geologist:_ Bentonite From: To:________ <br /> Grout From: To:_________ <br /> Public Water System Onsite:� [] Yes []No <br /> {O&IPLETlON [] Stove Pipe []Christie Box <br /> Domestic Well Onsite: [] Yes []No <br /> cx� � <br /> |fyes, location and distance: gnc <br /> SAMPLING <br /> Holding Temperature:� ���+pL�rxzw f-aOx <br /> uuapu��ow <br /> Method: <br /> Screening Method: <br /> Verified Chain ofCustody: [] Yes []No <br /> SPOILS <br /> Contamination Noted: [] Yes []Nu � <br /> /fyes,spoils storage Location: <br /> Covered: [] Yes []No � <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth _____u. <br /> Grout Material: <br /> Gallons ofGrout Used: <br /> TU Casing Type: <br /> []VVe|| Installation []VVe|| Destruction Blank Feet Screen Feet <br /> ' <br /> []Boring|nsta||ation �� ' <br /> `'-�orin� Destruction S|ot3izeBags ofCement: <br /> METHOD USED 8ags3ond/G/ave|: <br /> Type/BrandofBentonite <br /> []PressureGrout []OverDriU �� <br /> Filter Pack Type/Iize: <br /> [] G [] �]� // Type ufK4ethod: <br /> 1 5 3. 5 .10 Bentonite per 47 lb 1 1.411 2.471 <br /> Bentonite pet,94 lb 1 2.821 4-71 <br /> 5 25 so <br /> r <br /> 20 0 <br /> ^ / <br /> 10/16/2017 <br /> 1868E Hazelton Avenue Stockton, California 052O51 T 209468'34201 F 208464'O138 1 <br />