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SwaNITORING WELL INSTALLATION REPOhmwr <br /> Date: -7— q `D '7 CONSTRUCTION <br /> Premise Address: D f Total Depth 77 <br /> Screen Length (from) 72` (to) <br /> Well No.:��A W-16 - 77 Filter Pack (from) '7 (to) '77 <br /> Bentonite (from) (to) <br /> Inspector: V k--, r Grout (from) (to) <br /> Drilling rig type svn�`r r y a <br /> Permit No. to 6_0 1 99 .Auger O.D. b'-in,_4, 1-C'J <br /> ll Completion - Stove pipe/ u-istie ircle one) <br /> Drilling Company: W � C� �X 1218 ra1��r,� �r-0/ kl�us <br /> Driller: Max Kar iS� casing <br /> ASS;-5J4 rd 5 - i m ori e-S� er)'an MaY-W- _ height <br /> Consultant Cones�oar�- fRnilers ASIISo. (CRA � <br /> Geologist ►'Pir, ra 0 nCh -- <br /> Cd-)Il va vs COWF�CN° VN <br /> GD�e- <br /> SPECIAL PERMIT INFO. Ground Surlaca <br /> .55;46�L �' -cI s;If <br /> Distance to sewer line 2)n k n a LJ-)'Agrout <br /> _ 70`-(� -Ji/f <br /> Domestic well on site - (y 16j) 72 -77/ / <br /> If yes, location and distance - 77 8e). P41-1ft- <br /> N - so — <br /> _ - <br /> SAMPLING - A) Sgny,O�c.s �l/PiYG � ••.: <br /> !� <br /> Holding Temperature /U A <br /> Method = gave Pack <br /> Screening Method kA -- <br /> Tracking Sheet - (y/ n ) <br /> ft.'A <br /> SPOILS <br /> Storage Method 57s-- �r Ln.t mi'C_ MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y <br /> Storage Location Oh 5';+P Casing type .2 - hA NC, 40 <br /> Blank 2 ft. Screen ft. <br /> Slot size D 0 ZO 1 _ <br /> GROU'T'ING 4';k rJ—-Hags cement /0 r iZ" <br /> Buckets bentonitekx ajun,. a,`- <br /> Depth to water ^� 4Bags sand/gravel Lam;s La tri <br /> Mix Ratios '0r1/9-1 Filter Pack type/size 2- <br /> Installation Method e T­q Surge Block: - ( y n <br /> Quantity Installed �2 bmf id,r i f ZO Discussed with geologist: - ( y/0 <br /> p&y f � Type of method <br /> EH 29 29 <br />