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WNITORING WELL INSTALLATION REPO* <br /> " SUnn� j �lS <br /> 7 <br /> Date: 42 CONSTRUCTION <br /> Premise Address: ham Fer r Total Depth 3 <br /> Z Yi Screen Length (from) 17 ' (to) 22 ' <br /> Well No.: A S ' Filter Pack (from)IS . (to) .2 ` <br /> �" }nn t Bentonite (from) /2' (to) ' <br /> Inspector: yjCK,i A_("lh� Ae!' Grout (from) /2' (to) SUr qLm <br /> Drilling rig type <br /> Permit No. .Sf# f1 D 7 3 S"J Auger O.D. I.D. <br /> Drilling Company: <br /> Completion - Stove pipe/christie box (circle one) <br /> y!�� 1•tJ � ri �1 i�tL+ <br /> Driller: T7Yhe `, (lLYb IreZ casing <br /> Assfsf,,!— min Leq a- height <br /> Consultant Gretj-Vid Z"o M9A& <br /> Geologist " min �46 )4 a h W f o - <br /> 1—)) 1S S J. 2 ABOVE-GROUND <br /> IZI rek) tYOYY( r /ST COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. l4 Z 9 7 Ground Su face <br /> Distance to sewer line U n C o w sz` - 11.7 RRI grout <br /> Domestic well on site - 011' a, - lj- J /2- tt <br /> If yes, location and distance - tt <br /> ^' P A J7 ft. <br /> q <br /> SAMPLING �ri11¢st ,1t }� e e14 eV6� ebb <br /> �grsL�l �f wcicn = <br /> Holding Temperature 4r J I - VI,W Pack <br /> Method <br /> Screening Method P I R r> <br /> Tracking Sheet - (�n ) <br /> SPOILS // 3 r <br /> Storage Method o5�` !��/�j di-1/h" MATERIALS/DEVELOPMENT <br /> Contamination Noted - OV n ) V / <br /> / <br /> Storage Location �j s.'fG Casing type I S&k444 9(0 <br /> Blank /7 ft. Screen 5: ft. <br /> n414 I h4%/4)- Slot size _d o <br /> GROUTING on Bags cement 10 ?V <br /> it <br /> Buckets bentonite 1 a� �D 1yUJ Vy <br /> Depth to water ? ��/ ) Bags sand/gravel 1 S bQ�S SRdre ate <br /> Mix Ratios / 7,6 Filter Pack type/size 0 2- <br /> Ins[allation Method V41, bfrAf r,Surge Block: - ( y/ <br /> Quantity Installed ' J ' -r Discussed with geol st: - i n ) <br /> Type of method <br /> EH 29 29 <br />