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MONITORING WELL INSTALLATION REPOinf <br /> Date: ;1 \J�r-e 204 CONSTRUCTION <br /> JDR�� S. F}�1 � ks�--+T <br /> Premise Address: Total Depth_ 2� '( <br /> Screen Length (from) t; (to) 20 <br /> Well No.: w` I Filter Pack (from) (to) <br /> M _ Bentonite (from) <br /> �Cto) <br /> Inspector. t IMv S Grout (from) (t <br /> I Drilling rig type M <br /> Permit No. SEL©oy ©52-4 Auger O.D. 1 I.D. --6- <br /> Drilling <br /> w ; Completion tove pipe christie box (circle one) <br /> Company: �� •M <br /> Driller: casing <br /> Nl.S 35eht <br /> Consultant Ev-%$iL-o <br /> Geologist 1G�R� ( •- <br /> �eove•r.aouNo � <br /> OOWPLEEION C7iA1STY�OX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Grourd Surface 7— <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n) Z <br /> h• <br /> If yes,location and distance- <br /> ft. <br /> 0 <br /> SAMPLING N/Asecdon <br /> slotted <br /> Holding Temperature = grayw Pack <br /> Method <br /> Screening Method " — <br /> Tracking Sheet - (y/n ) ' <br /> 2-0 t<. _ 2C) n <br /> SPOILS <br /> Storage Method Stere-b G V7 -S" pz MATERIALS/DEVELOPMENT <br /> Contamination No—ted(y Api ?VC— <br /> Blank <br /> ` <br /> Storage Location p9 Casing type 2 Y `�C - <br /> Blank ft. Screen /� f <br /> Slot size Q .02O" <br /> GROUTING Bags cement <br /> � Cn 1 �. Buckets bentonite <br /> Depth to water '-4 Bags sand/gravel _ <br /> Mix Ratios Filter Pack type/size a <br /> installation Method Surge Block: -On) <br /> Quantity lnstalled Discussed with geologist: - W n) <br /> Type of method <br /> EH 29 29 <br /> /Z- 2- 0 ,(ec/ _ Aj / <br />