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MONITORING WELL INSTALLATION REPORT <br /> Date: -q4 CONSTRUCTION <br /> r AA�ress: \��Ul (Q) K� &Wyx'• Total Depth 3 1 ,2�,FTII : <br /> -�-�-?- , _ <br /> V L3-ZZ-CH) <br /> Z`#'�� Screen Length (from) �� (to)-Well No.: ON-52 �'�v2 Filter Pack (from) (� (to) -5q <br /> �o <br /> Bentonite (from) 53 (to) "T5.As- <br /> Inspector: Grout (from) ; -5 (to) <br /> Drilling rig type 4LUT--, Q2n_11f?_Y <br /> Permit No. UJ 25N'2`J Auger O.D. I tilI.D. <br /> n Completio - St ve pip /christie box (circle one) <br /> Drilling Com any:_-� ��'��JGWY�. <br /> Driller: ISL Tcasing <br /> J1 7M T height <br /> Consultanthom)A , <br /> 1}a� <br /> Geologist Jc( •- <br /> M _Ew <br /> ABOVE-GRCQND CHRMW-BOX <br /> COMPLETION COMPLE7ICN <br /> SPECIAL PERMIT INFO. Ground Surfacs <br /> Distance to sewer line grout <br /> Domestic well on site - ( y/ n ) ft. <br /> If yes, location and distance - ft- <br /> ft. <br /> O <br /> SAMPLING slorod <br /> aacicn <br /> Holding Temperature = g,�w Pacx <br /> Method <br /> Screening Method <br /> :C• <br /> Tracking Sheet - (y/ n ) _— <br /> tt. "� = M <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT// <br /> Contamination Noted - (y/ n <br /> Storage Location g type) Casio e pp U� �7,��1 a �� •�J �D <br /> t <br /> Blank ft. Screen ft. <br /> Slot size ®2 <br /> GROUTING ( Bags cement <br /> Buckets bentonite 2S <br /> FJ (]of,-/_ Z) <br /> Depth to water Bags sand/gravel <br /> Mix Ratios _ 1 4-4.h 4adL- Filter Pack type/.- <br /> Installation <br /> ype/sInstallation Method Surge Block: _f� n ) <br /> Quantity Installed _ Discussed with geologist: - y n <br /> Type of method <br /> EH 29 29 <br />