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MONITORING WELL INST TION REPT <br /> . f <br /> Date: I CONSTRUCTION . <br /> . J �. t <br /> Premie Address: �`7!� Total Depth .Ss <br /> i �,� f r 1 Screen Length (from) 414 (to) 5:5- <br /> Well <br /> S <br /> Well Na.: Yw/LLOUJ Filter Pack (from)_. _ 4*37 –(to) G'5� ` <br /> Bentonite (from) 3 5 (to) J9 3 7 <br /> Inspector: Grout (from) (to) <br /> ` Drilling rig type <br /> Permit No.' Auger O.D. I.D. _ <br /> 1.�I[,�I j_ Completion - Stove pipe/ch.rlstie box.. ,(circle one) <br /> Drilling Company: G! C 1. t.c�-(Q.� ��. a� I- watt <br /> I <br /> Drillel,: casing "' "''".`� <br /> 6 height <br /> C,r: <br /> g <br /> Consultant <br /> Geologist <br /> A OVE-GROUND <br /> COWLETION CCOMPLETION OX <br /> �LerlaN <br /> SPECIAL PERMIT INFO. G=nd Sulaci <br /> Distance to sewer line <br /> Domestic well on site - ( y/ n) <br /> If yes,`�locztion and distance - ft' <br /> SAMPLING tlotiad c <br /> Holding Temperature Y <br /> a gravel pads <br /> Method = ; <br /> Screening Method ; <br /> Tracking Sheet - (y/ n ) ^ — <br /> ` .x I <br /> Ii <br /> f <br /> II� �Gu`� 34,4,+ /Sum, <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT_ _ <br /> Contamination Noted - ( y/ n} <br /> Storage Location Casing type <br /> Blank ft. Screen ft, <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Deptl to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n} <br /> Quantity Installedd� �f ) Discussed with geologist: - ( y/ n ) <br /> EH 29�29 u`v ex kcV,,4 �lam?f> JU Type of method <br /> 41 Jf <br />