Laserfiche WebLink
�� N]O�OUyN <br /> � �8�Y��U�4�|UV EnA���00��t�d ������ ���a�ment <br /> COUNTY— <br /> Greatness <br /> Health --~ <br /> gmwa here, <br /> MOD'tO['DgUUeU/SU'| BO['Dg |OSD8[t'OD Report <br /> Date: Inspector: &TQA%a SXXtor, CONSTRUCTION <br /> Facility Address: 2902 A.G, SP frinc'r�' 1pj\v(i. <br /> Well Address: Tota| Depth:_______ <br />' VV |#h ' Drilling Rig Type: <br /> 3i| Boh <br /> Min 2^Annular EHDSeal V(��ffied: []Yes []No <br /> Screen From:_ To: <br /> Driller Onsite: <br /> Filter Pack From: To:__________ <br /> Geologist: Bentonite From: To: ______�_ <br /> � <br /> Grout From: To: <br /> - ____ <br /> Public Water System Onsite� [] Yes []No <br /> � COMPLETION [] Stove Pipe []Christ/e8ox <br /> ' <br /> Domestic Well Onsite: E] Yes []Nu <br /> casing <br /> |fyes, location and distance: height ' <br /> SAMPLING o . <br /> Holding Temperature: <br /> Method: <br /> , Screening Method' grout <br /> Verified Chain ofCustody: [] Yes []No <br /> 39D8LS ^' <br /> Contamination Noted: []Yes []No <br /> /fyes, spoils storage Location: / <br /> *mm� <br /> Covered: []Yes []No --- <br /> If yes, material: <br />, GROUTING or DESTRUCTION Total Depth: <br /> Depth to _---_ft. <br /> 1­2:�—It- <br /> Grout <br /> GaUnnsofGrout Used: ZG4.�bh MATE RIALS/D EVELO PM ENT <br /> Casing Type: <br /> []VVe | /nstaUadon []VVe| Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> LJ8ur�g|nsta/bt�nF�8ohn�Destn�ct�n ' <br /> 7~ � Bags ofCement: <br /> METHOD USED BaQsSand/Gravei: <br /> � <br /> []PreosureGnout []OverDri|| Type/Brand ofBentonite� <br /> Filter Pack Type/5ize: <br /> �Q Gravity []Tnemie []Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> g Bags uallons Ba <br /> Thickest Thinnest 41 Bags Thickest Thinnest 118ag5 Bentonite/Cement Mix 35 <br /> 2.5 5 1 5 10 1 Bentonite per 47 lb 1.411 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 lb 2.821 4.7 <br /> 10 20 4 20 AO 4 <br /> 20 40 8 <br /> 4�Cs \ro`q'- I0/16/2017 <br />