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ONITORING WELL INSTALLATION REPO* <br /> ,n"�.,�,yfu. �i� hanQ-.(✓Scres� � SfeF.i!'bs� <br /> Date: a e9r� f�"y 'CONSTRUCTION v <br /> Premise Address: I t? D O c�U r h 4 F r-rl go( Total Depth all � <br /> � Screen Length (from) /S (to) 070 <br /> Wel] No.: As-4 Filter Pack (from) /` (to) 201 <br /> '/ ■� �/ Bentonite (from) /I ` (to) / ' <br /> Inspector: Vick; Mrd tLhhz-(A Grout (from) <br /> Drilling rig type <br /> Permit No. Auger O.D. 8-i rLA I.D. 1 Y <br /> �` na Completion - Stove pipe/ stie bo '(circle one) <br /> Drilling Company: Y � n/ Dr i l� ; <br /> Driller: �(f,(n K IZ' e m �reL casing <br /> / height <br /> Consultant rrrn d nal Zero T <br /> Geologist / - T <br /> P/D ABOVE-GROUND ctw m eox <br /> p COWLEiION <br /> SPECIAL PERMIT INFO. � G=ndSL face <br /> Distance to sewer line /Z <br /> Domestic well on site - y ' l y <br /> If yes, location and distanc <br /> C <br /> SAMPLING 23 - 0.8 aloud <br /> taction = <br /> Holding Temperature .S° Goa&r _ P <br /> Method bldt .GL <br /> Screening Method D r <br /> Tracking Sheet - n ) <br /> tt. = a a ft. <br /> SPOILS / <br /> Storage Method �.S _ ��n� 0I re a,- MATERIALS/DEVELOPMENT <br /> Contamination Noted - (�}�� n ) r <br /> Storage Location Casing type - 1h C.t t SP�ICd�sc�� <br /> Blank I r ft. Screen <br /> Slot size 0 / 11 <br /> GROUTING Bags cement <br /> l.S•Buckets bentonitef'o-}<d <br /> Depth to water 3 Bags sand/gravel a S /6 e-Ito Sk d Sv P re»u <br /> Mix Ratios 16 bao s 4y q a A Filter Pack type/size f I' , <br /> Installation Method 1 ` fe Iypr.A,"Surge Block: - (y <br /> Quantity Installed4-rr,3 PZ bs Sr— Discussed with geologist: - (Cy/I n ) <br /> 4v" Type of method <br /> EH 29 29 <br />