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*MONITORING WELL INSTALLATION ROT <br /> Date:_ ( I 12�rfl 2 <br /> CONSTRUCTION <br /> Premise Address: r� ( �6Q� 4 �l / mss ¢¢ Total Depth 5- <br /> Well No.: LIM U 1 _ Screen Length (from)_ <br /> Filter Pack (from) (to) ? <br /> Inspector- _ f� _ Bentonite (from), <br /> Grout (from) 6a (to)_i�� <br /> Permit No, ;Z ou� Drilling rig type <br /> Auger O.D. I.D. <br /> Drilling Company: j t1 Completion - &tovz-pipe uistie z (cu--- c � <br /> Driller._ <br /> casing <br /> Consultant � height <br /> Geologist �'L/�n,n p.� —w-T <br /> .� <br /> ABCVE-GRCOND <br /> C0 VLZTION C4-G*-TY30X <br /> SPECIAL PERMIT INFO. OCOMPLznCN <br /> rwwnd Sufan <br /> Distance to server line <br /> Domestic well on site - grout <br /> If yes, location an stance n) <br /> IZ•�' ft. <br /> r• <br /> a <br /> SAMPLING - — <br /> 0 <br /> docwi __ 'c <br /> Holding Temperaturer i C'A sacicn = <br /> Method_."•(n�.,, „�, � - = p,vcl yadc <br /> Screening Method_ <br /> Tracking Sheet <br /> ii <br /> SPOILS <br /> n. <br /> Storage Method -AL-4 <br /> Contamination Noted - �y/n) MATERIALS/DEVELOPMENT <br /> Storage Location l <br /> Casing type z U °` <br /> Blank— t -t- ft Screen S' jt, <br /> GROUTING Slot size-- 102-0 <br /> Bags cement <br /> Depth to Water 2-0 t Buckets bentonite l <br /> Mix Ratios Bags sand/gravel /V 3 <br /> Installation Method Filter Pack type/size - /2- <br /> Quantity <br /> i <br /> Quan[iry Installed `9" -(_ Surge Block: - (yIn) <br /> Discussed With geolots[: - (yam) <br /> EH 29 29 Type of method <br /> ( ('1'16'2, -D AA W-3 0 <br />