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IRONITORING WELL INSTALLATION REPORT <br /> Date:_ A O f, 1 7 0 ) CONSTRUCTION <br /> Premise Address: -2/9 3a -7-";n 9)�VorL Total Depth �- <br /> Screen Length (from) 3 6 ' (to) /Q ' <br /> Well No.: 41/l 1,{J - J <br /> Filter Pack (from) 30 (to) 9 ' <br /> Bentonite (from) g ' (to) 7' <br /> Inspector: �i O I t-+n i Grout (from) <br /> Drilling rig type_ 6#7 6- <br /> Permit No. Auger O.D. �- in,�.h4ef T.D. 4,15 i r41 .c <br /> W � <br /> Drilling Company: vCompletion - tove pi christie box (circle one) <br /> � r i �� i n G <br /> Driller:__ �Y-0 YL j r e z d,; lie, c sing <br /> F�Sri�fiibrt� - ayr7� RAI he'ght <br /> Consultant_ o <br /> +�'Ca r! t' D,'L v,'L <br /> Inv <br /> 7rrL3 e o <br /> Geologist .a rd G-19 nd n JAtBOqVE-GG <br /> UND <br /> N CHRLM-BOX <br /> COMPLETICN <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line 13 n k' n o grout <br /> Domestic well on site - (y/ n ) U Y7 IGn Q _ } 2 1 <br /> If yes, location and distance - ft. <br /> m ,/ r G��rOl <br /> q <br /> C <br /> SAMPLING <br /> slotted = <br /> sacdon = <br /> Holding Temperature N "k - YJ 0 5L$M'd _ gra�+pack <br /> Method f{ <br /> Screening Method _ <br /> Tracking Sheet - (y/ n ) <br /> 2 C) ft. <br /> SPOILS <br /> Storage Method N /c MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) SuJ� <br /> Storage Location Casing type _'i ;2 (1 -40 <br /> Blank_ 10 ft. Screen <br /> Slot size_ 0. O i n i nukej <br /> GROUTING Bags cement alp <br /> Buckets bentonite_ �,,z ��� }1, . rn ted;,ry� L)t <br /> Depth to water_ J�,, S fee f" )0,5�— Bags sand/gravel 14 h`5-117 Ct�,Ygf,, gvY� c�fi <br /> Mix Ratios Q bo„t 2� Gla 11 mi o 41, %z a 9j-IA Filter Pack type/size �J-I I z- <br /> Installation Method_ n -Fr ti b�9 �� Surge Block: - (y/(n <br /> Cu mall <br /> Quantity Installed , P,(, S � Discussed with geologist: - (y/(j <br /> Type of method 1\I AEH 29 29 Gernti e'J a acyl: Tc,y�-�-17 V d T _ <br /> R Ty q, p <br />