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M TORING WELL.INSTALLATION REPOR4 <br /> Date: 5 CONSTRUCTION <br /> Premise Address: TY cam"` "+ Total Depth,__- <br /> RU <br /> / Screen Length (from) S Cto) s <br /> Well No.: RU/ 3 / 3 `4 Filter Pack (from) S • (to) �2 <br /> Bentonite (from)-21--(to) 3 a <br /> Inspector: Grout (from) 3 0 (to) qr' <br /> qq Drilling rig type CME SS <br /> Permit NoZ �/�3 Auger O.D. I.D. 3 <br /> . - <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> cas� height <br /> ng <br /> DDriller: � height � <br /> Consultant7/1 <br /> Geologist AjCV -GROUND C7tRIS7Y-3CX <br /> IONF'LETION COMPLETICN <br /> .�� Orcund Strlxt <br /> SPECLAL PERMIT INFO. <br /> Jl grout <br /> 'moo <br /> Distance to sewer line_ g, <br /> Domestic well on site • ( y/ Z ft. <br /> If yes, location and distance - 35g, <br /> ks. <br /> O <br /> slolttd <br /> SAMPLING sac-don _ <br /> n <br /> Holding Temperature — <br /> Method <br /> Screening echod d '1 +: <br /> Tracking Sheet y n ) ° SJr ft, <br /> • ,�$•.fir <br /> SPOILS <br /> Storage Methodt ze,s MATERIALS/DEVELOPMENT <br /> Contamination Noted - <br /> Storage Location tN Casing type <br /> Blank fL Screen_ l0 ft• <br /> Slot size 02.0 - <br /> GROUTING Bags cement <br /> c/ Buckets bentonite <br /> Depth to water Tb-S Bags sand/gravel <br /> Mix Rados3 r %Ba�t Filter Pack type/size � <br /> Installation Meth Surge Block: - (y A9 �:•l' <br /> Quantity Installed Discussed with geologist: - 1.71" n ) <br /> Type of method /Uo 64c- as&� <br />