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`.rONITORING WELL INSTALLATION REPG,.,� <br /> Date:_1[k Ito` CONSTRUCTION 3 <br /> Premise Address: L�� Total Depth 3 2. <br /> Screen Length (from) 2 (to) \'l <br /> Well No.: Filter Pack (from) 3 '2- (to)_l S <br /> Bentonite (from) i6ja- ( S (to) c ?Z_ <br /> Inspector. _ �� �a1/�„unL�� Grout (from) 3 (to) a.e� <br /> Drilling rig type <br /> Permit No. �9'� �-� �� Auger O.D. I:D:- •2 <br /> Completion - Stove pipe/ iristie box ircle one) <br /> Drilling ComQpany: � <br /> Driller: 1 �MrLAZY �C-4— casing <br /> ��� height <br /> Consultant a'y`S <br /> IV <br /> GeologistT <br /> A80VE-GACUND C-W*T f_WX <br /> COMPLETION COMPL.ETICN <br /> SPECIAL PERMIT INFO. Ground Surface , <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n) L.ft. <br /> If yes, location and distance - ft. <br /> SAMPLING -'-4e_Z - S ,,,filo-► .QNE�n�.I tloC.v.� <br /> h ._ <br /> ll1! <br /> tecicn <br /> Holding Temperature " <br /> T,rav9i Pacsc <br /> Method _ <br /> Screenin;Method ' <br /> Tracking Sheet - (y/ n ) Y <br /> ft. �`MWft. <br /> SPOILS So <br /> , w�� (Lia I � ��t so..:c� S►•K,[,l�N�" _� <br /> -�'�•�,,.� - N,,,«.{�Stoethod MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) ?VC- 51�_�p <br /> Storage Location Casing type 1 <br /> Blank L'1 ft. Screen /S ft• <br /> Slot size .s b2 o <br /> GROUTING Bags cement' <br /> 1 1�.jr v Buckets bentonite <br /> Depth to water 2 2 �a- �" Bags sand/gravel <br /> Mix Ratios Xb — Filter Pack type/size 2 <br /> Installation Method Surge Block: - (y/n ) <br /> Quantity Installed Discussed with geologist: - (y/n) <br /> Type of method <br /> EH 29 29 <br />