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i. . �NITORING WELL INSTALLATION REPOR <br /> MJ waJ rnu/ (#Ud <br /> CONSTRUCTION 112�i 5 0 '-f S <br /> Premise Address: f O 5� ly �A "Py Total Depth I S o — <br /> / - Screen Length (from) 0 (to 30 2S <br /> Well No. : rV� 0 �I/W 6i, Filter Pack (from) 5 0 (to <br /> r <br /> Bentonite (from) Z'I (to -ZY <br /> Inspector: lir Iia Grout (from) (to) 0 <br /> Drilling rig e <br /> Permit No. 9 ,a — ch'' Auger O.D. I.D. <br /> Completion • Stove pipe/clu•istie box (circle one) <br /> Drilling Company:mmmm(I- Vii. <br /> Driller: ) tl 'C'e casing <br /> Consultant height <br /> O� ��%� ( �-"`� <br /> 75 <br /> Geologist �)'� , L1';L�. '� 'I — •- <br /> ABOVEwGROUND CHAISTY BOX <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surlxw <br /> Distance to sewer line <br /> grout <br /> Domestic well on site - ( y / n ) , no <br /> If yes, location and distance - <br /> ft. <br /> ft. <br /> — m <br /> SAMPLING = ° <br /> cloned c <br /> aocdcn <br /> Holding Temperature u o (' — gaud pads <br /> Method = <br /> Screening Method `r = <br /> Tracking Sheet - y n ) <br /> ft. = tt. <br /> SPOILS <br /> f <br /> Storage Method � ^ MATERIALS/DEVELOPMENT <br /> Contamination Noted rc��• �L 2u <br /> Storage Location ' � Casing type <br /> Blank ft. Screen ft. <br /> Slot size Ol <br /> GROUTING & VAS V (e Bags cement <br /> tl <br /> Buckets bentonite <br /> Depth to water l / , � Bags sand/gravel <br /> Mix Ratios 3 U�b:V77 Filter Pack type/ • e <br /> Installation Me od Surge Block: - n ) <br /> Quantity Installed Discussed with geologist: - ( yn <br /> Type of method <br /> EH 29 29 <br />