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SALMON <br />N <br />�x <br />\,��s —COUNTY- <br />11�' 6rcatrteis grows herq. <br />Environmen' ' rnealth Department <br />Monitoring Well/Soil Boring Inspection Report <br />Dates IInspector: <br />Facility AUdre s KW <br />Well Address: <br />WP# Well#0.0( I <br />Soil Boring#: <br />Drilling company: <br />Driller Onsite: <br />Consultant: A2jrSfrc Ar>sncLe <br />Geologist: e <br />Public Water System Onsite: <br />❑ Yes ❑No <br />Domestic Well Onsite: ❑Yes ❑Na <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Screening Method: <br />Verified Chain of custody: ❑ Yes []No <br />SPOILS <br />Contamination Noted: ❑ Yes ❑No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes ❑No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth:___ <br />Depth to Water: Y1O t <br />Grout Material":._j��(A On/Ylo t { <br />Gallons of Grout Used: 3 `x <br />*ell Installation OWelbDestruction <br />OBoringInstallation ❑Boring Destruction <br />METHOD USED <br />❑Pressure Grout Dover Drill <br />❑ Gravity OTremie �pther: i� <br />CONSTRUCTION <br />Total Depth: _LU <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: <br />Screen Length From: <br />Filter Pack From:— <br />Bentonite From: I. To: <br />Grout From.' --O. To <br />COMPLETION O Stove Pipe <br />j29 Yes . ONo <br />To: <br />To: <br />�_- <br />QChristie Box <br />--J�f height <br />'Lf <br />tsovE �aouNn - - <br />COMPLE770IY TTEox <br />rOMP <br />CCMPLE71nN <br />C uind 5{..rxe <br />slow A <br />or�,e <br />�R. <br />e. <br />Z= ` <br />L+,rl paac <br />tt. �t <br />t <br />MATERIALS/DEVELOPMENT <br />k <br />Casing Type: f-/ Lf© <br />Blan_ '''.__Feet Screen_._ Feet <br />at Size: Q r o o`L" <br />Bags of Cement: <br />Bags Sand/Gravel: <br />Type/Brand of Bentonite: M e 1 44n <br />Filter Pack Type/Size: <br />Type of <br />_ Banfonite/Cement Mix 3 t Mix i f Mix <br />Benfnnifeper4716 7.41 2.47 <br />Benfomfe per U4 11) 2,Bz 4.7 <br />10/16/2017 <br />1888 E. Hazelton Avenue I Sfookton. CaGibmia 95205 I T 209 4B8.342D I F 2U9 464-6138 I wvnvslcehd cam <br />