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4 )DA0111H 4 <br /> 11%9a6-At['ro. <br /> U i-,l T Y-_.._... <br /> Mromiitodn�g We-11111.'So-H of-ii g insPeCtion Repf--jr'-- <br /> Date: 119 tiL Inspector: C€ rli S T,RU C-1 10 N <br /> Facility Address:--jA4Aj S. OHom at <br /> Well Address: Total Depth: <br /> wp=, 00140L W e I 14"': Drilling Rig Type: <br /> Soil Boring}: `\ <br /> Drilling Company: ANOPM Ito [Viin 2" Annular END Seal Verified: D Yes 'DNo <br /> Screen Length Frdm� To: <br /> Driller Onside: KO 401111k*l <br /> Consultant: Filter Pack From: To: <br /> Geologist: Bentonite I-rorn:— To: <br /> Grout From: To: <br /> Public Water Svstern Onsite: 1:1 Yes E]No 2DIA11,11 P LE-T fej--N� Ej Stove Pipe ElChristie Box <br /> Dornest;c Well Onsite: El Yes E]No <br /> H yes, location and distance: <br /> S 11 MP L I N G <br /> 1 1 o I cl J n g Tern p e ra-L-IJ re: P <br /> Method: <br /> Screening Method: tin i <br /> v <br /> Verified Chain 0-1 CLIStOdy: 1:1 Yes D-No <br /> P 0 1 LS <br /> Con-Larnination Noted: E Yes E,N,o <br /> If v-,-,s,.spoils storage Location: <br /> Covered: D. Y e s 0 N o <br /> V <br /> 11 ves, I-naterial: <br /> GROUTINIG or DFS TRUCTION Total Depth: <br /> Depth to Water: <br /> Grout(Material: IIIIIJAVA C(N*94-L E V E I P fvP,E-N!—1 <br /> Gallons of Grout Used: OS GO <br /> Casing Type: <br /> EIV-dell Installation Dhiell Destruction Blank -----r-eet Screen Feet <br /> OBoring Installation .Boring Destruction Slot She:& <br /> Bags of Cement: <br /> F,,A E T H 0 D USED Bags Sand/Gravel: <br /> L--I" Type/Brand of Bentonite: <br /> r ensure Grout El Over Drill Filter Pack Typel/Size: <br /> Ell Gravity ElTremle E3 Ot-her: y I D e of Method: <br /> C2menc 71b I N+zr.er Cement 903 <br /> nuns I s qns <br /> 110 <br /> pg S <br /> Ihin —i AAlt, trip P,,?i i C <br /> Thinn=,L <br /> ThidEs xF I x <br /> 5 I i I 10 i B 0 1 -h-)1 11'�G P-i 4L_ lb I f.4 71 <br /> 5io Ea n critic c- 41 lb 2.821 41-.7 <br /> H <br /> 1-5 1 3 -15 1 30 3 <br /> 10 2 0 4 20 AO 41 <br /> 12.5 25 5 2 5) so 5 <br /> F--IT I .0 i 6 I so l 60 6 <br /> 17.5- 35 7 <br /> .10 0 01 <br /> Ll '(1 <br /> 10/16"121.017 <br /> 1868 E.HaWart Avenue I Stockton, California 9520.5 I T 209 4,68--3420 F 209 464-0138 P wwvv.sicehd.ccm <br />