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i <br /> MLL <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: �� f D CONSTRUCTION L <br /> Premise Address:_--- 130 C 4 a n e, ��-rG ei, 'Total Depth <br /> Screen Length (from) (to) r <br /> Well No.: ' Sr Filter Pack (from) (to) 7,3 <br /> � Bentonite (from) -2-3 (to) ' <br /> Inspector: _ V;Gk j M C(.��tf4 t T Ln P.iGrout (from) 1 f3 ' (to) 5u Ir <br /> Drilling rig type C <br /> Permit No. _5 k �_0 Sq 44(o _ Auger Q.D. ja I.D. <br /> Completion - Stove pip stie �ox ircle one) <br /> Drilling Company:�p� ` 4 <br /> J <br /> Driller:— -- --- V1�t�n a� ' �{�.A 3 i(�S ��►�7� casing <br /> !}17 <br /> /� .Sigruf �i 111 7'Zish i U height <br /> Consultant 1r ig <br /> Geologist ._ <br /> ABOVE-GROUND <br /> COMPLETION Tx <br /> COMPLETIONSPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line �1 n kni)j w gtout <br /> Domestic well on site - (y/ ?j <br /> ft. <br /> If yes, location and distance -riot 4242) itA <br /> PI _ ft, <br /> Pki <br /> SAMPLING <br /> Holding Temperature _ �' 3a O <br /> Method _ i ACA i n d C AO)e.-' s-i �� _ gravel pack <br /> Screening Method D <br /> Tracking Sheet - ((fj n <br /> SPOILSS <br /> Storage Method S MATERIALS/DEVELOPMENT <br /> Contamination Noted - (01 n-) ii <br /> Storage Location _D_YL 5;1-e Casing type a - )2 R,h_ <br /> Blank ft. Screen_ ft. <br /> SIot size_ 4. 010 ;n L�-e.l <br /> GROUTING Bags cement Y -sa d <br /> Buckets bentonite Z '/,-`6w (S�- <br /> Depth to water ? Bags sand/gravel p -)12 r g Cra Id <br /> Mix Ratios !tans f1,WdPI'Filter Pack type/size 2 L t.spf Lr r` <br /> Installation Method O's ly Surge Block: - (©/ <br /> Quantity Installed 1 - �[i�S u'� Discussed with 12Quantity - <br /> 1�ft <br /> EH 29 29 usedf-h o-v�" 064rNV-570 MAI-L Type of method iAi 0 � <br /> V s.r,W �U r k re+c ed r+14 ria(fy PL Zc-,e"zeA-tV <br /> yyia i)Z a S`-5--6,01/ori of ezrn <br />