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N - <br /> MONITORING WELL INSTALLATION REPv. i <br />{ <br /> Date: Z ' Zfi " a CONSTRUCTION <br /> Premise Address: 10b 0 #161J07f Total Depth 0 8 <br /> Screen Length (from) 04a i2 (to) <br /> Well No. : Filter Pack (from) i n 4 . 4 2- (to) <br /> Bentonite (from) <br /> Inspector: L' Grout (from) q l (to) 1 <br /> Drilling rig tyRe_(21 <br /> i Permit No. Auger O.D. I.D. �D • 2 i7 <br /> Completion . Stove pipe/christie box (circle one) <br /> Drilling Company: W Gba J <br /> Driller; casing <br /> height <br /> Consultant Eevoki / PWAIMU � 7= . <br /> , <br /> Geologist I�Pr'( �I tYl ISdn� <br /> A80VE GACUND C1tRlMwaox <br /> CONFLETCN <br /> SPECIAL PERMIT INFO. t3raurd 3tatan <br /> Distance to sewer line Oran <br /> Domestic well on site • ( y / n ) <br /> If yes, location and distance • Q � ft. <br /> SAMPLING doroi <br /> secicn — <br /> j Holding Temperature Jr = wd Fadt <br /> Method fjSA - N?Uf SWDN <br /> r = <br /> i Screening Method — <br /> Tracking Shcet • v v n ) PAC . <br /> tr. <br /> j, SPOILS OJEp l mn1� UNl�ti�t�m N '� D - l <br /> Storage Method iCIVY/t N TD bE 11> tnu� MATERIALS/DEVELOPMENT <br /> ontamination Noted • C.� n ) It <br /> j Storage Location f� PJ5l1� Casing type Z SGk 9U • PJG <br /> t " """ ,,� " Blank Q t ft. Screen <br /> STSd0A ob62 10 ( or b f SIM't'P[v Slot size <br /> GROUTING SLA SI Wo Bags cement 1 <br /> 5NO)M 04 U KM . Bucket�bentonite 1 <br /> Depth to water Bags ga"Ulgravel <br /> Mix Ratios -<^ &A N , o / RS lbss8z f dit9 Filter racktype/size � # 3 <br /> Installation Method 111 ihIE Surge Block: • ( y / n r�� <br /> Quantity Installed Discussed with geologist: - L'J n ) <br /> Type of method F/A� <br /> EH 29 29 <br /> I <br /> f <br />