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SANrJ MIN Environmental Health Department <br /> —COUNTY— <br /> `�p�FozF"' Greatness grows Kerr. <br /> qq Monitoring Well/Soil Boring Inspection Report <br /> Date:'I,I, SWA1 4asbector: ' CONSTRUCTION <br /> Facility Address: ZAb \rJN <br /> Well Address: Total Depth: <br /> WP# wWLk b(3 kV1 Well#: 9 Drilling Rig Type: <br /> Soil Boring#: /V ' g Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: Screen Length From: To: <br /> Driller Onsite: AK <br /> Consultant: �,_�L Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ONO COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes []No casing <br /> If yes, location and distance: r!� height <br /> SAMPLING ABOVE-GROUND <br /> GowLET1oN CHR15rY•eOX <br /> Holding Temperature: comPLEfiON <br /> Method: 'around s'"t'c''T"—�� <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No —ft <br /> ft. <br /> SPOILS _ ✓ <br /> o ' <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: abttod <br /> a4c5on <br /> Covered: ❑ Yes El No <br /> grawl pack <br /> If yes,material: — <br /> GROUTING or DESTRUCTION Total Depth: 3Zr _ •. <br /> Depth to Water: \1/„"20 <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: S <br /> Casing Type: <br /> ❑Well Installation Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation III Bo ring,Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Pressure Grout Dover Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement471b Water Cement 941b <br /> allons Bags gallons Bags _ <br /> Thickest Thinnest kBags Thickest Thinnest kBags _Bentonite/Cement Mix 3% MIX 5% Mix <br /> 2.5 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 10 20 2 Bentonite per 94lb 2.82 4.7 <br /> 7.5 i5 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 35 7 35 70 7 <br /> 20 1 40 8 11 40 80 1 8 <br /> 10/16/2017 <br /> ncnnc I r nnn ecn nAnn I r nnn ece nno° 1 ....... _;.._u __.._ <br />