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ONITORING WELL INSTALLATION REPO <br /> �1�L13�1�1.5' <br /> Date: 5 ' 1 CONSTRUCTION <br /> Premise Address: I W. bL�stl CJF3C� Total Depth SDI <br /> F \ Screen Length (from) 407(to)�_ <br /> Well No.: (—IO )V O '2 Filter Pack (from)_�['�t'��—(to)�4 <br /> Bentonite (from)_ LT L4 _(to) 1' <br /> Inspector: Yl Grout (from) I (to) -0- <br /> Drilling rig type ( VA is 5S <br /> Permit No. CL 2 — 09 0 1�5 Auger O.D. D . S <br /> Completion - Stove pi el stie box ( cle one <br /> Drilling Company: <br /> casing <br /> Driller: STt�.IP iL �� � �� <br /> he±ght <br /> Consultant � � T <br /> Geologist O 1 ALxxh i r- l4 LL ,Pc ABOVE GRCUND <br /> CONFLETION CCMPL—BOX <br /> t;pMPLE7ICN <br /> Grou <br /> SPECIAL PERMIT INFO. �'� nd&uAxs +�� <br /> Ofout <br /> Distance to sewer line <br /> Domestic well on site - (y/(6) ft. <br /> If yes, location and distance - ft- <br /> tt. <br /> :gi = <br /> _ m <br /> - e <br /> a <br /> SAMPLING &lovad <br /> sor'cn <br /> 0 <br /> Holding Temperature 4 <br /> Method <br /> Screening Method <br /> Tracking Sheet - (M/ n) t, <br /> SPOILS n <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted • ryy n ) 105 44 <r-61 <br /> 40 �� <br /> Storage Location�� fZV•LLLt� A36 Casing type <br /> Blank 1S ft. Screen 25 ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite I � � <br /> Depth to Ovate J Bags sand/gravel <br /> Mix Ratios�d (�M �rS l „A F Filter Pack type/size <br /> Installation MSurge Block: - ( y/ n ) >J In <br /> Quantity Installed Discussed with geologist: - (y/ n ) Nt� <br /> Type of method t-1 la- <br /> EH 29 29 <br />