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PVIONITORING WELL INSTALLATION REPO <br /> Date: 1,4'133 ,2,4I o CONSTRUCTION <br /> Premise Address: &o' �(A�t silt- Total Depth �g'5 <br /> a � .t _3 Screen Length (from) ct (to) 27et Z <br /> Well No.: G` Filter Pack (from) 14• (to) bet <br /> Bentonite (from) let b (to) 5 <br /> Inspector: ngmle=4— Grout (from) 5 (to) [Z_ <br /> � G / 3$ Drilling rig type <br /> Permit No. Auger O.D. I.D. 54 <br /> /J Completion - Stove pipe/christie bo (cir <br /> Drilling Company: �,�.0-C GGItGGu-G�t- <br /> cle one) <br /> Driller:_ �rxtii 7casing <br /> height <br /> � � <br /> Consultant r [J"G6''uyr/ it' p' Z'TV <br /> GeologistY� <br /> ABOVEGROUND CNAISTY BOX <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground SuAaca <br /> Distance to sewer line O Ogrout <br /> Domestic well on site - ( y 40 <br /> If yes, location and distance - (� <br /> = m <br /> = m <br /> _ <br /> SAMPLING dcttad - c <br /> 9 wc5on - <br /> Holding TemperatureP <br /> Method = <br /> ack <br /> Screening Method <br /> Tracking Sheet - ( y/ n ) _ <br /> 27 <br /> SPOILS <br /> Storage Method 3-5S MATERIALS/DEVELOPMENT <br /> Contamination Noted( y/ n ) L/ACUIW + "' it A <br /> Storage Location iTh se Casing type 2 ? C- - <br /> Blank 7oL P ft. Screen <br /> lot size -O 2a <br /> GROUTING ags cement a <br /> ,/ u bentonite ( no <br /> Depth to water ^ 1Sl.-�,u�/ _ , =Gy�D� ags san gravel�� 7 �� <br /> Mix Ratios t S Filter Pack type/sizes <br /> Installation Method� Surge Block: - ( y n <br /> Quantity Installed Discussed with geologist: - ( y/ n <br /> v / Type of method <br /> EH 29 29 <br />