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MONITORING WELL INSTALLATION REPORT <br /> Date: Ad "-7-00 CONSTRUCTION <br /> Premise Address: t� <br /> � 3 (.�G/ C-G�C� Total Depth 7 <br /> ��� / I Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. �U Auger O.D. I.D. <br /> /, / Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: Z <br /> Driller: <br /> CHMM-80X <br /> Consultant --- COMPL-mN <br /> 2). <br /> < // ! LCASED WELL CONSTRUCTION DETAILGeologistE2 0-"NMq-.td B2-- A TaYCepTdeomq eo e <br /> B 3e n <br /> Ndb.Sum A— <br /> j E I--- <br /> M -+--C 82 0­a Bain to k <br /> OAwg w2na Mw 9-n Aww <br /> SPECIAL PERMIT INFO. C Tap«C_.V r:.V.ew. e <br /> fJI I / i I I ��.�.c.Cb►icjeeAaEri <br /> Distance to sewer line_ o C„k,i„5, w R <br /> 12 02 1 <br /> < wwir rr_ <br /> Domestic well on site - (y ! <br /> If yes, location and distance - F i. I 02 L'� �w <br /> j J2 , F C.wq 0— 2 h �� <br /> e2 C..V 0i Q w <br /> yy-S <br /> 0 fj, Vvbw:W L.19. '0 R <br /> A I :�. fMw.W IrtrnY Inm )7 b Y) n <br /> vu+a-nes sz. 0 W <br /> SAMPLING <br /> C I - B.ckNl hnn m E! R <br /> Holding Temp ature = <br /> o <br /> j — j K @ gwc rt0a t a— 1 1L <br /> Method <br /> Screening Method 0 VAAS_ MVft — <br /> Tracking Sheet - n ) i I=_ Iw�Y .tl� <br /> �+ 1 I <br /> � ' �2 5.Y 0an 3. a ss e <br /> . I I 1 I-€ � I sw nutasl rnaa:a�J.nxe. <br /> L K (.nv.l f-Ck !G b SOIL <br /> Pack M—M •3 Len.mr SPM <br /> SPOILS ' I- --8--- r L 8m S..1Na a <br /> is.Y M.ur� <br /> Y.tr.0"m-—.d lemon hatlY yrev+d Auf.C.. <br /> Storage Method !13(. f Ll�� yz�9Ojl__ MATERIALSmEVET.OPMENT g�VY C Lr <br /> Contamination Noted - (y, n' T Z ���� k 53. <br /> Storage Location uJ �r.�o Casing type <br /> Blank ft. Screen <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water l7 Bags sand/gravel <br /> Mix Ratios _ Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n) <br /> Type of method ' <br /> EH 29 29 <br />