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f ` SAN.dUMIN Environmental Health Department <br /> —COUNTY <br /> 1 _ <br /> Greatness grows here. <br /> \` Monitoring Well/Soil Boring Inspection Report <br /> Date? S ��1Tspector: CONSTRUCTION <br /> Facility Address:-\0 <br /> Well Address: Qu ov2l•Total Depth: <br /> WP# sS "\OCSO Well#: -ItYe Drilling Rig Type: 0 Lk-n <br /> SeiFBeririg#t: S - S.- <br /> 5�L 2" nnul r EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: t_, <br /> DrillerOnsite: Lo eQ Screen Lengt From: \ 0� To: 12Z <br /> Consultant: Lt2cr �c�_ ' 1� S Filter Pack From:g�. To: l?J� <br /> Geologist: <br /> Bentonite FromA\. To: <br /> 1 Grout From:s5yJ.� To: Rb' <br /> Public Water System Onsite: El Yes I/JNo COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes �No casing height <br /> If yes,location and distance: IFTLT M vzd <br /> SAMPLING ABOVE-GROUND <br /> CowLE 1CN COMPLE O <br /> Holding Temperature: cornpLErIoN <br /> Method: G=nesunaos <br /> Screening Method: Grout <br /> Verified Chain of Custody: ❑ Yes []No l itb tt. <br /> co L <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes []No = ' <br /> If yes,spoils storage Location: .wnod <br /> s4ction ., <br /> Covered: ❑ Yes ❑No <br /> VAVW pack <br /> If yes,material: c <br /> GROUTING or DESTRUCTION Total Depth:96 S�Q F� c 1 tip <br /> Depth to Water: - Z (A11 VI—tt. <br /> Grout Material: M t wc <br /> L MATERIALS/DEVELOPMENT <br /> Gallonssofof Grout Used: Z S A °A Casing Type:�)L <br /> OWell Installation ❑Well Destruction ScSx� J �Q��liank Feet Screen IC!?(10 Feet <br /> ❑Boring Installation ❑B of size: �•oring Destruction Bags of Cement: <br /> METHOD USED 51 ^ Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill S SAJ�P <br /> 3' �' Filter Pack Type/Size: <br /> ❑ Gravity I/Tremie ❑Other: 9Af ' 3- 4AgbJk1. Type of Method: <br /> Water Cement 471b Water Cement 941h j <br /> allons Bags allons Ba s <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonlite/Cement Mix 3% MIX 5°/n MIX <br /> 2.5 5 1 5 10 1 113antonits per47Ib 1 1.411 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94Ib 1 2.82 4.7 <br /> 7.5 15 3 15 30 3 -, <br /> 10 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> 15 30 6 30 60 6 <br /> 17.5 3 35 70 7 <br /> 20 0 8 40 80 8 <br /> 10/16/2017 <br /> A 0r. I 11 I._ A....... i f 4i 1.i..-. 1+..1:[,.-..ir nV•AC I T .A0 AOn nAnA I C 1n 1 Al Al 00 I ...........:....1.J <br />