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SAN JOAQUIN ii Fciitz ort,s rate 11 [Fles.At',,L, <br /> vv <br /> Monit...odrig Wen-111"Soil Boririg inspe-Cr-ticm, Report <br /> Date: Inspector: C410 C01,1STRUC '-OFQ <br /> F"a ci 1 i Ly A d d ress: OQA3 S, IK4qgLrl Ak <br /> -Well Address: To*Lal Depth: <br /> wp ooAA ribl, W e I I Drilling Rip Type: <br /> Soil Boring#: I Min 2" Annular EHD Seal Verified: 11 Yes 11 N a <br /> Drilling Company: AWW10 Screen Length Frdm� To: <br /> Driller Onsite: KM LJODC1111(tj <br /> Cons'JIL311t: Filter Pack From:_ To: <br /> Geologist: Bentonite F I-o m: To: <br /> G r 0 U t From: To: <br /> Public Water Systern Onsite: 10 Yes DNo <br /> I CCIA.1111P LETkON El Stove Pipe 0 Christie Box <br /> Domestic Well Onsite: n Yes ONo <br /> 'n <br /> 114 yes, location and distance: <br /> SAIMPUNG <br /> HKilding Tennperai_-Ure: M<)NI <br /> m et 1-1 o d: <br /> Scr,apning Mle"hod: <br /> 0" <br /> Verified Chain 0! CLIStDdx,/: 10 Yes O-No <br /> J.— <br /> SPOI <br /> Contamination Noted: El Yes EI N o <br /> 11 ves; spoils storage 1 ocation: <br /> Covered: 0 Yes ONo <br /> 11 Ves, mal.eriai: <br /> GROUTINIGorDESTRUCTION TotalDepth: <br /> Depth to Water: <br /> G ro Li t IVI a t e r i ak rOMALD CQ101 tt' R!A DE V E_10 P M,E P 1 T <br /> Gallons of'Grou'L Used: 1 60- <br /> k-asHIR I�/PE: <br /> DIVell Installation D/Vell DESILII-LICTi011 Blank Feet Scree,-i Feet <br /> OBoring InsiLallation SdBoring Destruction Slo L' Si-7e: <br /> Sags of Cement <br /> Bags Sand/Gravel: <br /> ME�HOID USED <br /> Ty <br /> O'Dressure Grout FlOver Drill ,peBrand of Bentonite: <br /> I FiPL-ar Pack Type,/SiZe: <br /> 0' Gravity 01-1 r e III i e El 0 IL.h e r: Type of Mle'Lhocl: <br /> 941b <br /> z I C?Melli.471b VV?.".Er Cemen, <br /> 2211-.15 Radlons <br /> T <br /> I i j Ck Eful Thinnast I <br /> Thd:-�= T 1 s ildix /0 <br /> j B e -L,c)I I It p e 47 b .4 2Ai,I <br /> 12 0 1)er 24 lb 2.821 41.71 <br /> i <br /> "D 15 <br /> I C. 20 4 4 <br /> 5 2= <br /> 1 <br /> so <br /> 60 6 <br /> -5 7 <br /> 10/161/21_01 <br /> 1668 E.Hazelon Avenue Stockton,Califomfla 9520,5 T 209 468.,3420 F 209 464-0138 1 www.sJcehd.ccm <br />