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&NITORING WELL.INSTALLATION REPO* <br /> -.� ydwrt_b'tr�tJv� <br /> '(i�LLQOld6tS��' <br /> Date: G 2 CONSTRUCTION <br /> Premise Address: W • C,6 Total Depth-------------- <br /> ` / \ Screen Length (from)4: , (to)�� <br /> Well No.: �I t� J Filter Pack (from) 4D (to)—L4— <br /> Bentonite (from)_ 14 (to) 12 <br /> Inspector: SCv 1 , Grout (from) 17" (to) -Z�-- <br /> Drilling rig type C 6 <br /> Permit No. q 2 09(e-;5 Auger O.D._ ) -'Z I.D. 2 <br /> Completion - Stove pipe christie box (circle one) <br /> Drilling Company:_ 4)✓ t�� <br /> Driller: c-�fuA1Sl lts +�M✓�t.� T hng <br /> eightt height <br /> Consultant <br /> Geologist �1�4 t��LU g�("-'2' <br /> gBpVE•GRCUND CHRIST(-80x <br /> CCkFL.ErION CCMPLEnICN <br /> SPECIAL PERMIT INFO. G= Steri <br /> Distance to sewer line <br /> Domestic well on site - ( y n ft. <br /> If yes, location and distance - ft. <br /> ft. <br /> = m <br /> — o <br /> = o <br /> — o <br /> SAMPLING �lorad <br /> auction <br /> Holding Temperature <br /> Method ca, � <br /> Screenin;Method <br /> Tracking Sheet - UY n ) <br /> SPOILS <br /> Storage Method L MATERIALS/DEVELOPMENT <br /> Contamination Noted - y n ) ��(l0 <br /> Storage Location ��1 (�lx ua�t t - Casing type <br /> Blank IS ft. Screen <br /> Slot size 1b <br /> GROUTING Bags cement <br /> Buckets bentonite l <br /> Depth to water fJlr- Bags sand/gravcl <br /> Mix Ratios GS I L a � 1 Filter Pack type/size �f�2 wx (3vn 'fl <br /> Installation Method e� (- Surge Block: - ( y/ n ) J Ira <br /> Quantity Installed Discussed with geologist: - ( y/ n ) I <br /> Type of method rY <br /> EH 29 29 <br />