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ONITORING WELL INSTALLATION REP04 <br /> Date: �' CONSTRUCTION <br /> Premise Address: �f� L . CIS � Total Depth 40 <br /> \ -F -- Screen Length (from) <br /> Well No.: y UJ - l x'12 Filter Pacack (from) (to) _ <br /> cam, t�Bentonite (from) 13 (to) I t <br /> Inspector. S � �t3vl�l —, s' Grout (from) II (to) H <br /> Drilling rig type <br /> Permit No. Auger O.D. /D 2S I.D. 25 <br /> Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company: LOLIr>he <br /> Driller. eEx-ke-"L<- 4"'�KcasLng <br /> height <br /> Consultant n t1st A,- <br /> Geologist pNk(-P' AgpyEGRCIIND <br /> COWLBTION COMPL ncN <br /> CCMPLr`TICN <br /> SPECIAL PERMIT INFO. Grour>d Sutacs 7 � <br /> Distance to sewer line <br /> ASO lllag0i l�tA�> grout <br /> Domestic well on site - ( y/ j ' ft, <br /> If yes, location and distance - ft. <br /> R. <br /> m <br /> _ o <br /> -- a <br /> SAMPLING doral = c <br /> sac7en <br /> Holding Temperature <br /> Method <br /> Screening Method !7� <br /> TrackingSheet - [YY n ) F. <br /> ft. — ft• <br /> SPOILS <br /> Storage Method YU ILC- MATERIALS/DEVELOPMENT <br /> Contamination Noted - (YYna <br /> Storage Location µ� C�a�tt w� Y Casing type-4 5CA 40 INC. <br /> Blank I':�" ft. Screen 2_t5—ft- <br /> Slot <br /> t5ft•Slot size �O <br /> GROUTING Bags cement <br /> Buckets bentonite / <br /> Depth to water Bags sand/gravel <br /> Mix Ratios ( ° { 1 D Filter Pack type/size <br /> Installation Method Surge Block: - ( y/ n ) N7� <br /> Quantity Installed Discussed with geologist: - ( y/ n ) t +f <br /> Type of method N i ra- <br /> EH 29 29 <br /> vto- 111P <br />