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SANAMIN Environmental Health ®apartment —COUNTY Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date:12 TUl2tStpB3pector:.(��- CONSTRUCTION Facility Address:_$9so TbWN !� Well Address: Total Depth: WP# 'l.�-k Czb\.'( Well#: PA -2 Drilling Rig Type: Soil Boring#: A 1119 Min 2"Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company: IA b3 Driller Onsite: %,M or 0 O Screen Length From: To: Consultant: Filter Pack From: To: Geologist: �A_)�Ll_. Bentonite From: To: Grout From: To: Public Water System Onsite: ❑ Yes []No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes []No casing If yes, location and distance: height tGeL � SAMPLING ABov&anouND CHRISTKBOX Holding Temperature: cowLE ION COMPLETION Method: emdn°S`"I'°' Screening Method: grout Verified Chain of Custody: ❑ Yes ❑No —h tt. SPOILS o Contamination Noted: ❑ Yes ❑No If yes,spoils storage Location: �Wttad s�c5on Covered: ❑ Yes ❑No g'a'Vo �P= If yes,material: '. � GROUTING or DESTRUCTION Total Depth: �i _ •. Depth to Water: v� 'l 0 tt• — tt Grout Material: MATERIALS/DEVELOPMENT Gallons of Grout Used: BLS iAo Casing Type: l ❑Well Installation C�Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation ❑Boring,Destruction Bags of Cement: M TH�OD USED Bags Brand f el: i Pressure Grout Dover Drill Type/Brand p Bentonite: / Filter Pack Type/Size: ❑ Gravity ❑Tremie ❑Other: Type of Method: Water Cement 471b Water Cement 941b allons Bags Rallons Bags Thickest Thinnest #kags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 3% Mix 25 5 1 s 10 1 Bentonite er47lb IlAl 2A7 5 10 2 10 20 2 Bentonite per 94lb 1 2.82 4.7 7.5 15 3 15 30 3 - 10 20 4 20 40 4 12.5 25 5 25 50 5 15 30 6 30 60 6 17.5 35 7 35 70 7 20 40 6 40 00 0 10/16/2017 AO?A 1 T /1 A ACO nAnA 1 r 1rNr Ar A r\A•]a I ....... ..:..�LJ