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SARP OU10 <br /> _COUNTY— <br /> „ Environme•I Health Department <br /> ` <br /> •` cri Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: On Inspector: CONSTRUCTION <br /> Facility Address: _ 2 �� <br /> Well Add �q: Total Depth: Q,�`t 1 <br /> WP# (/ Well#: M 57 Drilling Rig Type: V d1c, <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: / <br /> Driller Onsite: Screen Length From: To: S� <br /> '4 <br /> Consultant: Filter Pack From: To: 2 1 � <br /> Geologist:�z1. � Bentonite From: ;m To: <br /> Grout From:_ To: <br /> � <br /> Public Water System Onsite: ❑ Yeslo COMPLETION ❑ Stove Pipe p Christie Box <br /> Domestic Well Onsite: ❑ Yes Iq6 V0 caain4 <br /> If yes, location and distance: height <br /> SAMPLING o ABove.cADUND CHRIM-eox <br /> Holding Temperature: C DOWLE ION CCMPLEnoN <br /> Method: G3 nd Suiacv.--ate <br /> Screening Method: f rN orout <br /> d'•N <br /> Verified Chain of Custody: ❑ Yes ❑NoII <br /> 1 .n tr, <br /> _tL <br /> SPOILS �t <br /> tv 0 <br /> Contamination Noted: ❑ Yes No _ <br /> If yes,spoils storage Location: r0aSL� <br /> Covered: EJ Yes Pio x014144 slatted <br /> = 3 <br /> _ ons vk <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: r <br /> Depth to Water. S S <br /> Grout Material: ^ - MATERIALS/DEVELOPMENT 1gc,� <br /> Gallons of Grout Used: /V Casing Type: f2\/ C- `1'0 <br /> Well Installation ❑Well Destruction Blank— 9+0 Feet Screen 15'- Feet <br /> On Vic Slot Size: 010 <br /> ❑Boring Installation El Boring Destruction Q; 30 <br /> y Bags of Cement: <br /> METHOD USED Jok r a 1 Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill ea 'Pr, , 4j, Type/Brand of Bentonite: <br /> �� �vm+� Sck �F�ilter Pack Type/Size: <br /> ❑ Gravity �1L Tremie Other: <br /> SS 1� ;� Typ <br /> e <br /> 1of Method: <br /> K(1/„/Q lM brie o <br /> Water // Cement 471b Water cement 941b { 0 5%►1 ' t •(V Cb' p^ <br /> Ilons Bas allons BagsV <br /> Th ckes Thinnest 48 Thickest Thinnest Mgs Bentonite/Cement Mix 3% Mix 5%Mix <br /> 2. 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 10 s 10 20 Bentonite per 941b 2.82 4.7 <br /> 7.5 15 3 15 30 3 <br /> 10 20 4 20 40 4 <br /> 115 25 5 50 5 <br /> 1 30 <br /> 15 30 80 8 <br /> 7 30 <br /> 17.5 35 7 35 70 7 <br /> 20 g40 8 rj 40 80 8 -11 <br /> �2. Hit <br /> bAi �Cp l (�1 CJS K4 l'h Q, MNIS�K 10/16/2017 _ <br /> 18 8 E. Hazelto venue 1 Styo�c,,tc n, lifQ rnia 95205 I T 209 468-34201 F 209 464-0138 1 www.sicehd.com <br /> �jt/ bog5 <br />