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�:'MONITORING WELL FNSTAI LATION REPoN C <br /> Date:.11 - - CONSTRUCTION <br /> Premise Address:_Ow IU. � ^ Total Depth 90 <br /> IScreen Length (from)_ <br /> Well No.: �9� Filter Pack (from) SO (to) <br /> ! Bentonite (from) (to) <br /> Inspec'or: Grout (from) (to) <br /> I Drilling rig type <br /> Permit No. V�e_ Auger O.D. I.D. <br /> �"" Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: Mq 7' casing <br /> height I <br /> Consultant <br /> Geologist V �, •- <br /> 1I _�— pCHRJM_aox <br /> J180VE-GRQIlNI <br /> ii COMPLETION COMPLETIO <br /> SPECIAL PERMIT INFO. JhW •• q1> Ground Surface <br /> •f4 <br /> Distah' a to sewer Iine ? yr %j'C--O grout <br /> Domestic well on site - (y,CD •`(] t�G 3. <br /> ft- <br /> I% If yes,`location anddistance - t I ft. <br /> worm <br /> W - _ ,.� -C- _ •+m <br /> SAMPLING z1ofted — o <br /> soclon <br /> Holding Tempe graw <br /> Method It O' v !Jt-P 'q' — P i <br /> Screening Method / <br /> Trackifig Sheet -(:Y�Yn ) x L- <br /> IF <br /> SPOILS <br /> II ' <br /> Storage Method 03. Ikk J tt A1' MATERIAL�MEVELOPMENT <br /> Contamination Noted <br /> 'Storage Locationk Casing type <br /> = ' Blank R ft. Screen 10 ft. <br /> Slot size ,,, 010 <br /> GROUTING • �• Bags cement <br /> Buckets bentonite l 3 O <br /> Depth-to water 2 3 Bags sand/gravel <br /> Mix Ratios _ '* ti/I Filter Pack type/size 2 Z <br /> Installarion Me od Surge Block: - Cy/ n ) <br /> �. Quantity Installed'� -t `� Q :Discussed with geologist: - :(y/ n ) <br /> s z* Type of method <br /> .A EH 29,29 <br />