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MONITORING WELL INSTALLATION REPOR0 <br /> Date: /7 " OS CONSTRUCTION <br /> n J(� pp [ <br /> Premise Address: .ZS?7 5 s aIIOYS rtv, foss u Ser e De (from)-0 D S ([o) 40 ' <br /> Well No.: by- / 9 Filter Pack (from) I O S r (to) f7 7 r <br /> Vic <br /> Bentonite (from) (to)_ R 3 <br /> Inspector. Vic C' Grout (from) 3 ' <br /> p Drilling rig type 1 <br /> Permit No. S 1R nn�s�'1 3 7 Auger O.D. 1 D " LD. S <br /> A! Completion - Stove pipe/cliristie box (circle one) <br /> L <br /> Drilling Company: 6 11aard <br /> 1 � trte Y; J1 <br /> casing <br /> Driller: �_ �F' height <br /> rrS9i S�'4N�— - TI IYL r 11 els- <br /> Consultant 5i rjQ t1,r - <br /> Geologist 00.�i i n 0 S - ABOVE-G8CUN0 CtW1SiY20X <br /> COWL.`TZN COMPLEMN <br /> SPECIAL PERMIT INFO. <br /> proof <br /> Distance to sewer line <br /> Domestic well on site - it. <br /> if yes, location and distance m / n <br /> — <br /> _ 'al <br /> m <br /> _ o <br /> C <br /> o <br /> �lorad <br /> SAMPLING <br /> Holding Temperature— K A <br /> Method_ _ <br /> Screenin;Method <br /> Tracking Sheet - (y/ n ) _ <br /> I Q 57 n. .—. = n. <br /> SPOILS P1 <br /> Storage Method R o i�-o t �i its c^^�i �t a �6S stav7;0*kMATERIATS/DEVEI'OPMENT <br /> Contamination Noted - (y n � <br /> Storage Location,_ Casing type <br /> Blank D ft. Screen—LE—ft. <br /> N 1`tin slot size <br /> kydr �`-Bags cement 33 b��r�`��' BA �er TK. <br /> GROUTING . uckets bcntonue s <br /> �, �f Bags sand/gravel i <br /> Depth to water z <br /> Mix Ratios3 )of <br /> < 584 t Y o :0 } I Filter Pack type/size <br /> Installation Method r � '�J S �Surge Block: - (y/ n0 ,7 <br /> Quantity installed <br /> eDiscussed with geologist: - <br /> n ! I Tne-e ed ntj 1 e) e- <br /> EH 29 29 <br />