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MONITORING WELL INSTALLATION REPORT <br /> D1-1U-,nn�) Q,bav f 90 'FJ <br /> Date: AtJa U.3� 020 a.0 1 0 CONSTRUCTION <br /> Premise Address: 6-3q W. (�)A St' Total Depth � <br /> Screen Length (from)_ Io (to) ' <br /> Well No.: .27 Filter Pack (from) G 0 (to) 3g <br /> \ /^��-,, Bentonite (from) 31 ' (to) 36 ' <br /> Inspector: Y 1 P k N1 Lt_ur hn Grout (from) 34 -(to),5- L <br /> Drilling rig type C <br /> Permit No. SR, Q 0 G D 6q 2 Auger O.D. $ �h ��, I.D. 41 1 <br /> L Completion - Stove pi christie o (circle one) <br /> Drilling Company: All WN- )I A-ba ndo,n me n,l <br /> Driller:_ Jua rL Q rte N1 i _ la �_ � casing <br /> L height (! <br /> tCrCN <br /> Consultant Adyant" 6-eo Cnv.r o nme,J2jGeologist LL) i S GQ � erABOVE-GROUND <br /> COMSPLETION <br /> SPECIAL PERMIT INFO. G=nd Surfacs <br /> Distance to sewer line Un K-n ntJp. grout <br /> Domestic well on site - ( y/( ft <br /> If yes, location and distance - <br /> N R _4f ft <br /> to <br /> m <br /> SAMPLING yb�ys / SIGO o aloud <br /> ' SS &scion = <br /> Holding Temperature ° (/ <br /> Method j C e :,nom r•�4 <br /> Screening Method P ) <br /> M, <br /> Tracking Sheet ( y/ n ) RE <br /> ft. r 0 ft. <br /> SPOILS <br /> Storage Method .S - ew d—r& MATERIALS EVELOPMENT <br /> Contamination Noted - y n ) COV _ QJQ ,'f e- 7y/Z,11—J-1- <br /> Storage Location ea s'' -6 Casing type .2 - 3/-r Cq <br /> Blank 16Q ft. Screen a6 ft. <br /> o v Slot size <br /> GROUTING Bags cement , t b,,;AS Baj4/,- <br /> f Buckets bentonite CeAte Y14 46l-64r <br /> Depth to water �" Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method -r 'e- Surge Block: - &n ) <br /> Quantity Installed o;2 b4,- 'e4eP Discussed with geologist: - (�/ n ) <br /> EH 29 29 / Type of method Gk <br />