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'*wJNITORING WELL INSTALLATION REPOI.s' <br /> Date: 7- /P/P ` 0 7/ CONSTRUCTION <br /> Premise Address: �e2� G����f�- �VWVA Total Depth AO <br /> Screen Length (from)_� (to) � <br /> Well No.: _ M 1r1/ - �G `-� Filter Pack (from) (to) _ <br /> ,i1 . Bentonite (from) �3,J' _(to)�— <br /> Inspector. V r�n Grout (from) 4! (to) S q ae­e— <br /> q Drilling rig type n--a 77" ,,c_ r" <br /> Permit No. l"�(Z��1 9 / Auger O.D. I.D. <br /> Completion - Stove pipe/ e o (circle one) <br /> Drilling Company ia,.d we"t <br /> Driller: /A1 a4 � j-1 s� / casing <br /> �}SS ►3�2�T� \J;rri7y� ��yt e3� Qr��ii r b4Ci1,. height <br /> Consultant 7i R oy S <br /> Geologist Lau re,, o UGn n A _ AVE-GFtCUND <br /> COMSPLETtON jC4MX*V't-EMT1CN <br /> SPECIAL PERMIT INFO. around Surface <br /> i` Za �y( ' <br /> Distance to sewer line �� grout <br /> Domestic well on site - ( y/ n3S ' 4/�,S -�'°l�y sr <br /> If yes, location and distance - �//,S' -S�i <br /> 9r�lLol <br /> y¢// <br /> 17- S'0' <br /> v- m <br /> 111 a <br /> p ) D r id _ i <br /> ;;: _ <br /> SAMPLING - Ale 61t.7���eS <br /> sacicn _ � <br /> Holding Temperature IIIA <br /> Method nt A — <br /> Screening Method NI A <br /> Tracking Sheet - ( y/ n ) Ill A <br /> SPOILS <br /> Storage Method .,�.�- �,��n, /.lf(i�2C /,�S{�e MATERIALS/DEVELOPMENT <br /> Contamination Noted - <br /> Storage Location �h.S i 4-e Casing type 4-i Pt6l, Pv C - Yo <br /> Blank ft. Screen 5- ft. <br /> Slot size 0 Z <br /> GROUTING Bags cement 1 _ <br /> // led- <br /> Buckets bentonite i'le '/ <br /> Depth to water �f�`i a Bags sand/gravel <br /> Mix Ratios S, - hates f4vi It"c te. Pdr- lFgn (7 5 1�- y# Filter Pack type/size i <br /> Installation Method -�r`�d,,,, e !n V-0- Surge Block: - ( y/ <br /> Quantity Installed - -/d p Discussed with geologist: - ( y <br /> 44 f3 ru-1s }I 2A Type of method <br /> EH 29 29 <br />