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SWAMI <br /> —COUNTY Environme4o Health Department <br /> f f;ax+ r Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: , Inspecto :�� CONSTRUCTION <br /> FacilityqAdresVI470 <br /> Well Address:_ _ Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: - —1 <br /> Drilling Company: Min 2"Annular EHD Seal Verified: ❑Yes ❑No <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: �— Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No <br /> casing <br /> If yes, location and distance: height <br /> SAMPLING <br /> ABOVE-GROUND <br /> HoldingCtig5ll'-@Ox <br /> Temperature: coNFLETION COMPLETION <br /> Method: C3ratind Salop <br /> Screening Method: ori <br /> Verified Chain of Custody: ❑Yes ❑No — h. <br /> K. <br /> SPOILS —n — <br /> £� m <br /> Contamination Noted: ❑ Yes <br /> If yes,spoils storage Location: = o <br /> alottcd <br /> Covered: ❑Yes ❑No — <br /> Ifyes,material: Z' = °f9°IPack <br /> GROUTING or DESTRUCTION Total Depth:. <br /> Depth to Water: <br /> Grout Material: <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> Elwell Installation Elwell Destruction Blank Feet Screen Feet <br /> OBorj,ng Installation orng Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> VGravity ❑Tremie ❑Other: Type of Method: <br /> Water cement 471b Water Cement 941b <br /> Ilan Ba allons Ba <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3%MIX 5%MIX <br /> s 10 2 10 20 <br /> 2.5 s 1 s 10 1 Bentonite per 47 Ib 1.41 247 <br /> 2 <br /> 7.5 15 3 15 30 3 Bentonite par 94 Ib 1 2.821 4.7 <br /> 10 20 4 20 40 4 <br /> 12.5 25 s 25 so s <br /> is 30 6 3o 60 6 <br /> 17.5 3s 7 35 70 7 <br /> 20 q0 8 40 00 8 <br /> b 10/16/2017 <br /> 1868 E. Hazelton Av nuc�Stckton,alffoml95205 I T 209 46&34201 F 209 464-0138 t www.sicehd.com <br />