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�8N]Q8 �lUTN <br /> � ����V��Q���U|N Environmental ������ ���a�mment <br /> ~ -�-'C(�UNTY--- " <br /> G,eutneo 9m°n here. <br /> Monitoring VVeU/S(]'| Boring |nspeCƒ'OD Report <br /> Date:;4 Inspector:��l _�w� CONSTRUCTION <br /> Well Address: Total Depth: <br /> VV � DhUingRig Type: <br /> oil" o'" g Min 2" Annular EHDSeal��d: El Yes EJ No <br /> Drilling Company:Driller Onsite: Screen Length Frono� To: __________ <br /> R� Pock From:Filter To: <br /> Consultant: �---Bentonite From:Frum� To� ^ <br /> Geologist: �------ �---------- <br /> - ' - ' ' ' ' Grout Fronn: To:__________ <br /> *�~ <br /> Public VVaterSystem Onsite: [] Yes �u�» COMPLETION w [] Stove Pipe []Christie Box <br /> Domestic Well Onsite: [] Yes �No caoing <br /> |fyes, location and distance: <br /> SAMPLING <br /> Holding Temperature: w"='`='=° coMPasiOw <br /> G��a�� . <br /> Method: <br /> Screening Method: grout ' <br /> Verified Chain ofCustody: [] Yes El No <br /> SP<}U� / <br /> � <br /> Contamination Noted: [] Yes []Nu <br /> � <br /> |fyes,spoils storage Location: � <br /> Covered: [] Yes []No / <br /> |fyes, material: <br /> GROUTING or DESTRUCTION jff <br /> Total Depth: ������_ � <br /> �� ����' <br /> DepthtoVVater ------ - <br /> Grout Material: MATERIALS/DEVELOPM ENT <br /> Gallons ofGrout Used: <br /> Casing Type: <br /> LJVVeU |nstaUation e| Detruct�n Blank Feet Screen Feet <br /> y� _--------- <br /> Slot Size: <br /> []BohngInstallation LJBohngDestruction <br /> Bags ofCement: <br /> METHOD USED 8aXpSand/Grave|: <br /> []Pressure6rout []OverDri|| Type/Brand ofBentonite: <br /> Filter Pack Type/Size: <br /> kra«ity []Tremie []Other: Typeof��ethod: <br /> Water Cement 47 1 b Water Cement 94 lb <br /> gallons Bags gallons Bags <br /> Th!Aest Thinnest Bags Thickest Thinnest 4 Bags —BentoniteXement Mix 3% Mix 5% Mixi <br /> t2V 5 5 10 1 Bentonite per 47 lb 1.41 2.47 <br /> 10 2 10 20 2 Bentonite per 94 lb 2.82 4.7 <br /> 10 20 4 20 40 4 <br /> 15 30 6 60 6 <br /> 1O/16/Z017 <br />