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MONITORING WELL INSTALLATION RE ORT <br /> Date: O/ CONSTRUCTION <br /> 4 Premise Address: _ .3Q f1yl P f,_, Peef Total Depth _ T <br /> Screen Length (from)' 4-5- ' (to) -2,.S' <br /> Well No.: - Filter Pack (from)- __45 ' (to)_- 2.31 <br /> Bentonite' (from) .Z3 ' (to) I % �, .. <br /> Inspector: Me-Me-ed rh2 CW Grout (from) j 8` -(to) Sar -0— <br /> _.J Drilling rig type <br /> Permit No.--- -- SAuger O.D. g-iwW7 I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> .Drilling Company: <br /> Driller- <br /> casing- .lf'^c5alill,l�l . <br /> (J <br /> /�;�;s — r�i xl S/t ► '�' � height _ <br /> Consultant (:pyl a,r Ear--k igehnnlnq ie5 <br /> .J <br /> Geologist <br /> r ' <br /> BO E-GROUND <br /> cOWPLET DN ON <br /> SPECIAL PERMIT MO. Ground Surtxa <br /> Distance to sewer line_ l)rt Kn DW rn grout <br /> Domestic well on site - (y/0 r J8 <br /> If yes, location and distance - 23 ft. <br /> -- n o+ a,oa1►'c�sb le ['��,Reaar+'nc�� zSft. _ <br /> SAMPLING slotc�d = <br /> -40 - 3,7ff N = B <br /> sacion <br /> Holding Temperature_ <br /> Method -C. -n le),- A. -= Qravei pack <br /> Screening Method El 17 <br /> Tracking Sheet - (� n } . <br /> .a• <br /> SPOILS <br /> Storage Method 4 S;+0 MATERIALS/DEVELOPMENT <br /> Contamination Noted - 0YY } <br /> Storage Location_ @Y1.S i Casing type <br /> Blank .ZS ft. Screen ft. <br /> Slot size d -r Yt <br /> GROUTING Bags cement 1 _S �g s <br /> r �%ob;lps'PBuGktrts bentonite .Z s -Ib s C20U <br /> Depth to water 1 Bags sand/gravel d 6," "s <br /> Mix Ratios �7- b N fitda �.Filter Pack type/size I �p�jb <br /> Installation Method_ 6 u Surge Block: - (G/ <br /> Quantity Installed___ <br /> Discussed with geolog st: - (�/ <br /> 14104-e-- ur 10hlrl"J Type of method uj P11 <br /> EH 29 29 <br /> Usk �urkr��L PorflcLrCp-�- r .IZ7 'mom 'n q SSC�r/ung. <br /> r� <br />