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SAN JUAUUIN Environmental Health Department —COUNTY \ , `'40,0,e?' Greatness grows here. MonitoringWe�All/Soil Boring Inspection Report � Date:2Z S�hS}l nspector: L1 CONSTRUCTION Facility Address: q0 'Mwofk Well Address: Lk Total Depth: WP# jw!n (5jg \1-,\ Well#: Drilling Rig Type: Ui1_8Q n 4-.' F Nyo 1- Min 2"Annular EHD Seal Verified: ❑ Yes El No Drilling Company: t)O!iA,%nX-_�LC, Driller Onsite: �MQ��yj � Screen Length From: To: Consultant: �F '~ �J�)�� 9NA5� �1g17 Filter Pack From: To: Geologist: Bentonite From: To: Grout From: To: Public Water System Onsite: ❑ Yes ONO COMPLETION ❑Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes I2No casing If yes, location and distance: __�� height , _QVT SAMPLING ABOVE-GROUND CciL PLETx7N CHRISTY-BOX Holding Temperature: cornplFTtoN Method: CitosiM Surlacs "'+ Screening Method: Grout Verified Chain of Custody: ❑ Yes El No 1 tt• tt. SPOILS _ft. Contamination Noted: ❑ Yes ONO __ r If yes, spoils storage Location ` slotmd `-s — S ; Covered: ❑ aac5onYes ONO If yes, material: _ •;; GROUTING or DESTRUCTION Total Depth: 3V ?. Depth to Water: \�i. 'Lb' Grout Material: IN) PST" MATERIALS/DEVELOPMENT Gallons of Grout Used: 4a 4- 113 Casing Type: ❑Well Installation Vwell Destruction T Blank Feet Screen Feet ❑Boring Installation ❑ Slot Size:Boring.Destruction Bags of Cement: METHOD USED Bags Sand/Gravel: ]Pressure Grout Dover Drill Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravity ❑Tremie ❑Other: Type of Method: Water Cement 471b Water Cement 94lb allons Bags allons Ba s Thickest ruin st gBags Thickest Thinnest #Bags BentonitelCement Mix 9% Mix 5% Mix 2.5 s 1 5 10 1 Bentonite per 47 Ib 1.41 2A7 5 10 2 10 20 2 Bentonite per 94 Ib1 2.821 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 7 201 40 0 11 40 80 0 10/16/2017 /.�IIA.....i.. ncnnc 1 T OnM ADO OAn^ I nnn AOA A4nO 1 ........J....LJ ..��