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SAN,JUMIN Environmental Health Department —COUNTY— . _I�taP'�° Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date:'I,�1�201b*ector: !t3"` CONSTRUCTION Facility Address: ^CbW " C-_ Well Address: Total Depth: WP# 'L"', Gb\`l Well#: CAA -Z. Drilling Rig Type: Soil Boring#: Min 2" Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company: l,b , y�� v. �� Screen Length From: To: Driller Onsite: p Kk0, Q� Consultant: Filter Pack From: To: Geologist: Bentonite From: To: Grout From: To: Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes ❑No oastng If yes, location and distance: f� netena SAMPLING ABOVEGROUND Holding Temperature: CONPLEr10N COOMPLETiON Method: Ground S'"i'°' Screening Method: grout Verified Chain of Custody: ❑ Yes ❑No —tt tt. SPOILS 7c = '. Contamination Noted: ❑ Yes ❑No — :ii: If yes,spoils storage Location: ,bnoa m Ion Covered: ❑ Yes ❑No c gravig pocic If yes, material: GROUTING or DESTRUCTION Total Depth: Depth to Water: vim.. '�• ft. 2Ftt. Grout Material: Gallons of Grout Used: MATERIALS/DEVELOPMENT Casing Type: ❑Well Installation / well Destruction Blank Feet Screen Feet ❑Boring Installation ❑Boring Destruction Slot Size: Bags of Cement: M THE OD USED Bags Sand/Gravel: ��jj/ Pressure Grout Dover Drill Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravity ❑Tremie ❑Other: Type of Method: Water Cement 471b Water Cement 94lb ailons Bags allons Bags Thickest Thinnest k ags Thickest Thinnest ueags BentonitelCement Mix 3% Mix 5% Mix 2.5 s 1 5 10 1 Bentonite er 47 Ib 1.41 2.47 s 10 z 10 20 z Bentonite per 94 Ib 2.82 4.7 7.5 15 3 15 30 3 30 20 4 20 40 4 12.5 25 5 25 s0 5 15 30 6 30 60 6 17.5 35 7 35 70 7 20 40 1 40 80 8 10/16/2017 A 040 1-' 11 1�� A....... 1 [•��1.{.... L...nL�...l�11G�lOL 1 T n/�O A/SO AA/f0I C / An_A f%4�0 1 ........ ...��LJ ..� ...