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MONITORING WELL INSTALLATION R TORT <br /> Date: 5-16-2oiY <br /> CONSTRJCTION <br /> Premise Address: 1245 W. CHAlzTcc vwy 25' <br /> Total De th <br /> WellNo.: Mvv-11, Mw-l2 f l+w-ij Screen L gth (from)' Is (to) 25 <br /> Filter Pa (from) 13' (to) 25 <br /> Inspector: Bentonite (from) r r ' (to) 13' <br /> Grout (from) see (to) n' <br /> Drilling type 13K-'61Permit No. Auger O . 8" ID <br /> Drilling Company: <br /> de D�wNG Completi - Stove pipe/ •'stie box. (circle one) <br /> Driller: FRA 1� pmF(L,z <br /> casing <br /> Consultant G2•.✓N9 height <br /> ZEQo 'T 'z'7 g lS �SNC. <br /> Geologist A"'4— Dew rr <br /> ABOVE-& XJND <br /> cowLm CN C�WISfY-80X <br /> SPECIAL PERMIT INFO. COMPL.ETiON <br /> - 6rcund Stalaco <br /> Distance to sewer line 100+ grout <br /> Domestic well on site - (y n <br /> If yes, location and distance- 1 I • tt. <br /> l5 ft. <br /> SAMPLING — o <br /> on <br /> Holding Temperature — <br /> Method " = ynvsl pack. <br /> Screening Method <br /> Tracking Sheet - (y/n) <br /> tt. is' n <br /> SPOILS <br /> Storage Method ss GgKJNyM4 MA'ER1ALS EVELOPMENT <br /> Contamination Noted- y n) <br /> Storage Location Casing type c_N y° rj(. <br /> Blank i5 $ Screen <br /> GROUTING Slot size e-01 <br /> Bags cement <br /> Depth to water 13 Buckets bento 'te' <br /> Bags sand/gra el <br /> Mix Ratios Filter Pack typ /size +t2- 12 <br /> Installation Metho_d__ — _Surge Block: - .y./� <br /> Quantity Installed — <br /> Discussed with geologist: - (y/n) <br /> EH 29 29 Type of metho <br />