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%. 40NITORING WELL INSTALLATION REPO. <br /> J <br /> 12/fo �� �Casln ✓ I well <br /> Date: S �,,15I� CDnae JCc) CONSTRUCTION <br /> Premise Address: 9045 W✓✓1y1" "I Oub Total Depth 80 - So,-,,4 h - S <br /> s cL 6V I`, Screen Length (from) (to) 6 <br /> Well No.: Mw I� Filter Pack (from) k6 (to) (- <br /> Bentonite (from) !06 (to) (o Z /z <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: 5 casing <br /> /n� height <br /> Consultant -�l 4.1-�el <br /> Geologist <br /> PLO , ;}PI ABOVE-GROUND CHAISTYBOX <br /> COMPLETION <br /> 55- 5LO - Op �s�nx. COMPLETION <br /> SPECIAL PERMIT INFO. P� <br /> Distance to sewer linegroutDomestic well on site - (y/ n ) _ fZ t I rtilJcN• <br /> ft. <br /> If yes, location and distance - tynclocio <br /> ft. <br /> o <br /> SAMPLING DIRML{G1 _ 55 slotted = c <br /> b<)-ew u serJon <br /> Holding Temperature = gravel pack <br /> Method <br /> Screening Method CI u l I g _ <br /> Tracking Sheet - ( y/ n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type�1,PVC <br /> Blank ft. Screen___P_ft. <br /> Slot size O 20 <br /> GROUTING Bags cement <br /> Buckets bentonite 2- 5.14 Coate PelCoate Pee <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size 05 <br /> Installation Method Surge Block: - (y/ <br /> Quantity Installed Discussed with geologist: - (3/ n) <br /> ' 'o Type of method <br /> EH 29 29 1 - .SfGtICd 1W,4- VjGVQ6toLt <br /> Filled u)( jil"tau"5 wwcl vqq h-e <br /> (^� OAF 0 1-1-1 CL1)v%ciL t NV 04-V vl� . <br />