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+..MIONITORING WELL INSTALLATION REpt, .r <br /> weWryry 4✓lsfGl l (Jru,)+CQ <br /> Date: I/i Qt/= ! 1217-6i-+ CONSTRUCTION <br /> Premise Address: fur 52 Couniti✓1 CtVtj Total Depth $1:) <br /> Screen Length (to) <br /> Well No.: M 1 s (� Filter Pack (from) 1'5 4 t <br /> (to) G� Co <br /> Bentonite (from) te(o (to)� <br /> Inspector: �fAl Grout (from) (to) <br /> Drilling rig type Re / wad Rot <br /> Permit No. Auger O.D. I.D. <br /> / <br /> Drilling Company: Completion//- Stove pipe/christie box (circle one) <br /> (�c'�' � ,^ <br /> Driller: GVftS �T �l ( Q casing <br /> height <br /> Consultant C a�bm(-' r T <br /> Geologist I v CFpI vii T <br /> ABOVE-GROUND __ <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. i / Ground Surtaes <br /> � <br /> Distance to sewer line ia`r',' groutIi <br /> Domestic well on site - / n ) <br /> If yes, location and distance - <br /> SAMPLING ID dotted = B <br /> Wv-v on <br /> Holding Temperature ND IIPPack <br /> U^ LbeSd <br /> Method q Pro. Sx -abtld Iv w000012taw) — vivo' <br /> Screening Method I U I meda&/L !h <br /> Tracking Sheet - (y/n ) <br /> SPOILS 3 S � <br /> Storage Method Ut V31 r5 - --c'myLQA (M- c.(t5}7o5�p MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n <br /> Lt n <br /> Storage Location Casing type <br /> Blank (o ft. Screen_-j ft. <br /> Slot size O I D <br /> GROUTING Bags cement � p <br /> r Buckets bentonite 2 9 ` <br /> Depth to water VU CA Gt - Cease Bags sand/gravel <br /> Mix Ratios L1 Filter Pack type/size <br /> installation Method Surge Block: - (y/trz <br /> Quantity Installed Discussed with geologist: - 01:Y n ) <br /> Type of method <br /> EH 29 29 <br />