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W JUAQUIN—COUNTY Environmental Health ®apartment <br /> 1 <br /> Greo tress grows here. <br /> ( �Z'IrTs s Monitoring Well/Soil Boring Inspection Report <br /> Date:\ `kpector: CONSTRUCTION ��bQ <br /> Facility Address: ubq P"z QbU57� <br /> Well Address: Total Depth:_ <br /> WP# \)')Rq bo b Well#: Drilling Rig Type: <br /> Soil Boring#: cAl Q rL` &09-�3,Drilling Company: Min 2"Annular END Seal Verified: Yes ❑No <br /> 5�1 cSl1Pc— <br /> Driller Onsite: SjQ Screen Length From: To: <br /> Consultant: Filter Pack From: 5 To: U( <br /> Geologist: C.DeBa bD Bentonite From: To: 3 <br /> 1 Grout From:_ To: bv�.Q-F• <br /> Public Water System Onsite: ❑ Yes 1 No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes MN casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> CowLErION COMPLY iON <br /> Holding Temperature: cotrtaleTioN <br /> Method: emun°s"i"' -:F — <br /> Screening Method: or«rt <br /> Verified Chain of Custody: ❑ Yes ❑No —tt <br /> tt. <br /> SPOILS k <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes,spoils storage Location: sbnod <br /> s4rlon <br /> Covered: ❑ Yes ❑No <br /> VZVW Pack <br /> If yes, material: <br /> t ' — <br /> GROUTING or DESTRUCTION Total Depth: . <br /> Depth to Water: tt tt <br /> Grout Material: N tC MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: bC Ci OA <br /> Casing Type: QbtjA - TUjbtj3 <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation PBoring.Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout Dover Drill <br /> Filter Pack Type/Size: <br /> Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement471b Water Cement941b <br /> ailons Bags allons Bags <br /> Thickest nest Bags Thickest Thinnest 4Bags BentonitelCement Mix 3% Mix 5:%Mix <br /> z.s s 1 5 10 1 Bentonite per47lb 1.47 2.47 <br /> s 10 2 10 20 2 Bentonite per 941b1 2.821 4.7 <br /> 7.5 is 3 15 30 3 -, <br /> 10 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> is 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 1 40 1 8 11 40 80 1 8 <br /> 10/16/2017 <br /> 4avn r ,1___u.... n....... 1 na__:.a.._ n..1:a.....:.. ncnnc : r nnn ADO onnn , � nnn nr_e nnoo 1 .........:....4J --� <br />