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L.KONITORING WELL INSTALLATION REPS <br /> Date: 0- 2- 'T L4 CONSTRUCTION <br /> Premise Address: Z4t D 0 I) 4 Total Depth <br /> Screen Length (from) 3a (to) b <br /> Well No.: '' 6 w " ) _ Filter Pack (from) 30 (to) 75- <br /> Bentonite (from)_�(to) _ <br /> Inspector: Grout (from) (to) b <br /> Drilling rig type-1'1,1c,b 1 t <br /> Permit No. I eµ(,T1�" 19', Lf l y Auger O.D. q 0/1-( <br /> Completion - Stove pipe Christie box ircle one) <br /> Drilling Company: U <br /> Driller: to casing <br /> j � f o� F he, <br /> Consultant J'ri'�'t"'M A�� `�' '4 -VV-F <br /> Geologist <br /> A80VE-GACUND CHMM-Box <br /> COWLS CN COMPLEnON <br /> SPECIAL PERMIT INFO. Ground Six+ <br /> pip <br /> Distance to sewer line 5 grout <br /> Domestic well on site - (y/ <br /> If yes, location and distance - <br /> v <br /> SAMPLING •lottod <br /> socicri <br /> Holding Temperature Yw <br /> ack <br /> Method 4- F <br /> Screening Method ? : _ <br /> Tracking Sheet - (U n ) testi vUc <br /> SPOILS <br /> Storage Method Atli �Lv MATERIALS,/DEVELOPMENT <br /> Contamination Noted • /n ) r/- <br /> Storage Location Casing type <br /> A Cok o5Itc, �� 5 � � eptcecki Blank—­—LE—ft. Screen 2- <br /> PLkIft 1ft'�VTivc" C' LI Slot size • U2� <br /> TI <br /> GROUNG �YAV 1 tb 0", �Qprop �� ,b 5 <br /> 5d Bags cement 4 <br /> r k Buckets bentonite I -- <br /> Depth to water �' « U. Bags sand/gravel <br /> Mix Ratios _ Filter Pack type/size 3 <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> L4 Type of method <br /> EH 29 29 0" L -2 <br /> 171 <br /> C>"Z <br /> L✓"L 1.L rVLD tJ/�0 �✓` <br /> t" Ioce4L�"j <br />