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o s✓J LSC <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: S- 2 6 - 9 CONSTRUCTION <br /> Premise Address: 3 1/3 -7 6-�`e Total Depth (, 3 / <br /> Screen Length (from) uo a (to) `! <br /> Well No.: /n w.-/P Filter Pack (from) L a- (to) Lf q , <br /> Bentonite (from) Lt q (to) Lf -7 ' <br /> Inspector: C' • a Grout (from) `1 z (to) ',­j e <br /> Drilling rig type I--w i I o-, S Le A­ <br /> Permit <br /> Permit No. Ois7/z- Auger O.D. B I.D. Ll V-1 " <br /> Completion- Stove pipe/christie box (circle one) <br /> Drilling Company*_ Ca <br /> Driller: (a veC L,rr`sLc'`e casing <br /> S/v S'v/ - Co y('.2- T height <br /> Consultantcr� /��'-s o� s �'tg� � T <br /> Geologist 'evGric ca't 5- Pic.-c e - ABOVE-GAOUND \ ' <br /> CCt,P'rc-i)ON SPL E71 cN <br /> SPECIAL PERMIT INFO. Cmand Sulwv <br /> proof <br /> Distance to sewer line u k- w <br /> Domestic well on site - Cy/ n ) Cy s ea.0 t c. ' T it- <br /> If yes, location and distance - fL <br /> _ = e <br /> — e <br /> / / TGE cam., ,C 4.T"&," <br /> SAMPLING :torted <br /> Holding Temperature „nom Pack <br /> Method '- <br /> Screening Method = _ <br /> Tracking Sheet - (y/ n) <br /> =� T = T tL <br /> SPOILS <br /> Storage Method g*i -10--, ' �� "-"'��✓ MATERIALS/`DEVELOPMENT <br /> Contamination Noted - (y/5�-) <br /> Storage Location ,Ates 447-- &..as<c sA. a.= p - Casing type P✓ <br /> Blank Z/61 ft. Screen, 1 s ft <br /> Slot size d� <br /> GROUTING Bags cement /�- <br /> Buckets bentonite ft-, r 4- <br /> Depth to war Bags sand/gravel <br /> Mix Ratios Filter Pack type/size :#- z /L 5 w m/ <br /> Installation Method �e�ti-,. .,:e a- a�..�-��.� Surge Block: - Co n ) <br /> Quantity Installed K s ti wt Discussed with geologist:; &/ n ) <br /> Type of method •o'" r w <br /> EH 29 29 <br />