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r <br /> *,.,NITORING WELL INSTALLATION REPOI,./' <br /> Date: pe4y'"Y-0 8. 10-OR CONSTRUCTION <br /> Premise Address: S<5-6 W, Cta riz WO Total Depth <br /> Screen Length (from) 5U (to) elr <br /> Well No.: M W- / --SD Filter Pack (from) S?) , (to) <br /> VBentonite (from) q-3 , (to) U <br /> Inspector: J�d'k, M � <br /> Me a r'�rt a Grout (from) (to) S-a •�,,Et� <br /> Drilling rig type n-1-a say,t� <br /> Permit No. 0�$'a 6, A"er- . . (y',vz ,1, i$ <br /> Completion - Stove pip nnstie box circle one) <br /> Drilling Company: W DG <br /> Driller:_M i)(9- 1N; I He--n son casing <br /> hTs;s+art+s : 6 r►4n M4r back • R09er Xrnene'z T Theight <br /> Consultant �Qs+oaa_ -Rvv�rs so. /�(Z A) <br /> Geologist W; I l k i r e14 n 2 -- <br /> ABOVE-GROUND <br /> COMPLETION Ct fFi15TY-80X <br /> SPECIAL PERMIT INFO. Ground Surface .�..� <br /> Distance to sewer line 3a �ep� grout <br /> Domestic well on site - (y,tD) T 40 ft. <br /> If yes, location and distance - 3 ft- <br /> -ft. <br /> v; o <br /> C <br /> SAMPLING •lored y _— <br /> secicn <br /> Holding Temperature Af A "< <br /> Method So; l SI-rrY' cev)ye'V tyr'-f'1-i is <br /> VIV91 pack <br /> Screening Method P t-D S1 4j S7) -cell O <br /> Tracking Sheet ey n ) <br /> SO ft, =� _ <br /> --. tr- <br /> SPOILS <br /> Storage Method �S'q4 (r,, rums_ S-'aY,-.�4v- MATERIALS/DEVEI.OPMENT <br /> Contamination Noted - (y/n ) 4 Zo �t�,✓t•y Lcl "� <br /> Storage Location L oto W. Chd rfa-,r Casing type e2'1 V, sD�1'a&4t_40 <br /> Blank 4'G- ft. Screen <br /> ti 33 444/rns 64 weje-- Slot size 0.O D <br /> GROUTING auLd .� I �ovs Bags cement <br /> SV1R_"- GeA V,}� Buckets bentonite lb a- o A ol `YBc�;P <br /> Depth to water S Bags sand/gravel - 0 - CEmcx <br /> Mix Ratios :4-7-74--lb r Ti trip Filter Pack type/size 2 -L— <br /> Installation <br /> Installation Method Po., 1 'L_CresSurge Block: - (y/n <br /> Quantity Installed 4 q4-tL .gams b�,k v� Discussed with ge gist:. - (y/D <br /> Type of method <br /> EH 29 29 <br />