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...(4f .._...m_ <br /> _ ONITORING WELL INSTALLATION REPORT - <br />' } Date:__ -il_- I CONSTRUCTION <br /> Premise Address: V r ee-_� Total Depth. <br /> Screen Length (from) 9y, (to)/Q.. <br /> Well No.: Y1/ " D _ Filter Pack .(from) 7e) <br /> Bentonite (from). (to) 5 '-` <br /> Inspector: Grout (from) $I' (to) <br /> Drilling rig type _ <br /> Permit No. Auger O.D. P.m I.D. y ` <br /> Completion - Stove pipe 'stie b (circle one) <br /> . Drilling Company:�1"e Ci 5 i�n S Q �l?-�rRq _. <br /> Driller: TUY1 U �Dhlt YEf e� casing <br /> height . <br /> Consultant _ omnmf -reP. <br /> Geologist- a h e-DOk- U •- <br /> ABOVE-GROUND <br /> COMPLETION <br /> .. COMPLEnCN <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line grout <br /> Domestic well on site - (y _ 1 �, B. <br /> if yes, location and distance - S . <br /> 1�n tt. <br /> • rrt:� O <br /> SAMPLING Clotted — o <br /> taction — <br /> Holding Temperature__ ° <br /> Method ' 71`w Pack <br /> Screening Method Ir '} <br /> Tracking Sheet n ) 9r4 AirC — <br /> s7va1 <br /> W;� ft. _ <br /> r( 71) tt. . <br /> SPOILS <br /> �41w �r i UGn V <br /> Storage Method. , -q�y«r,. Gl�ryne,f Q M_ A_TERIALS/DEVELOPMENT <br /> Contamination Noted -6V n <br /> Storage Location_-__ Casing type <br /> Blank f,6 . ft. Screen / 0 ft. <br /> Slot size 1 0 <br /> GROUTING Bags cement 4 7-I b _1{ 1� <br /> r Y4 V buckets bentonite�f ` o ff <br /> Depth to water _ �] ags sand/gravel16,0 <br /> l��j <br /> Mix Ratios84?-14S N lj��C—/1 f of Ujd9_,: Filter Pack type/size '2112— <br /> installation <br /> zInstallation Method. $IW4 Y ,p; Q� _ Surge Block: - (:p' n ) <br /> " Quantity Installed _ _J6,g++rf Discussed with geologist: - C 7 n ) <br /> EH 29 29 1J S eDI` 0- .0 . QAOt-Qlla6rr Type of method u j,&1l b i e ce <br /> G Ta u i wd,$ made ,�• S� <br />