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Y <br /> —I'AONITORING WELL INSTALLATION REPO T <br /> Date:_ Od4v ke--r- CONSTRUCTION <br /> Premise Address: 1730 � Total Depth. 2�^ <br /> t, Screen Length (from) (to) <br /> k 32 <br /> Well No.: Filter Pack (from) ' (to).__ 2 O ` <br /> 1l � Be)toni[e (from)} ` a (to) ZRI <br /> Inspector. , ?� Grout (from) 2� (to) r�d 6e <br /> P' J Drilling rig type t � <br /> Permit No. U d 1 — Auger O D._� ;vt{' I.D. 25 � <br /> Completion - Stove pipe/cl-uisde box (circle one) <br /> Drilling Company: <br /> ,hy4 <br /> Driller:._ V S �1� he-icas; ng <br /> rb�AS � .� e_cht: <br /> ConsultantCa--et! E� i�.�. �p_/.'li�rzoT rrn �_ej n G. <br /> r <br /> s <br /> Geologist ABOVE.ORCUNp <br /> h�P l..�i b N Cku ZTY-Ba X <br /> CO <br /> SPECIAL PERMIT INFO. t=rd Sul," <br /> LX rctut <br /> Distance to sewer line <br /> Domestic well on site - {y Al�) <br /> if yes, location and distance - LO ft. <br /> . .2 ft. <br /> r <br /> C <br /> O <br /> SAMPLING :tarsi <br /> NA <br /> soc�cn <br /> N �t Q cS"d 1 !� �,fGj.�.. <br /> Holding Term�perature �� �'�r-<X <br /> Method _— <br /> Screening Method :r , <br /> Tracking Sheet 4�.,L <br /> Z. .ft. tt. <br /> SPOILS - <br /> Storage Method JrS gIIG e MATEWALS/DEVE[.OPMENT <br /> Contamination Noted - (y/ /,� a ?`'1/L <br /> Storage Locatio) Casing type ft <br /> Blank 3 2r ft. Screen <br /> Slot size i <br /> GROLMNG nags cement - <br /> e. <br /> Buckets bentonite 3 '� 9 <br /> Depth to water 3 Bags sand/gravel - 10.4 <br /> Mix Ratios ^'` f � �� Filter Pack type/ •ze 3 <br /> �stallatiorn Method i » Surge Block: - cy. 'Fz ) <br /> QuantitylnstalIed -V t �Lr Discussed with geologist: - n) <br /> Type:ofmctltod r ov <br /> EH 29 29. - <br />�.�;. it's . )0.ew� eeAL S V AI O <br /> f r <br />