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SbNITORING WELL INSTALLATION REPO <br /> c/G,rt - s J n nJv t qb0 V <br /> Date: CONSTRUCTION <br /> r <br /> Premise Address:—/G 0 ��y� q / i�T� �Q( Total Depth <br /> cJ Screen Length (from) �L2i ,3` (to) ZZ. d <br /> Well No.: As- 1 Filter Pack (from) 2 .Od (to)V. �9 <br /> Bentonite (from) /9 (to) /G <br /> Inspector: L Grout (from) <br /> Drilling rig type 0- <br /> Permit No. .SR Q/'/ Auger O.D. -i . , I.D. 4, as <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: V i� W YjQ -CoWe: 7S- <br /> Driller:— <br /> SDriller: Wa VY7 0 IR 'era an hileto —S— casing <br /> / height <br /> Consultant"67 <br /> T�t <br /> Geologist ri ( �/0Yr- ._ <br /> ABOVE-GROUND <br /> COMPLETIONGiAIS'1Y-BO <br /> ON <br /> SPECIAL PERMIT INFO. Ground gurf� <br /> Distance to sewer line 'rgigfi s U n �(n a�,, 'w3T� I D Grout <br /> Domestic well on site - y n ) <br /> If yes, location and distance - f5 31-S re ft. <br /> as 0.3 = <br /> R <br /> O <br /> C <br /> SAMPLING — <br /> slonndon = 8 <br /> Holding Temperature <br /> Method �� i h /ei r� " _— Gni P <br /> ack <br /> Screening Method 1 D r <br /> Tracking Sheet - n ) (i12S <br /> eft. = drft. <br /> SPOILS <br /> Storage Method S - // ^f MATERIALS/DEVELOPMENT <br /> Contamination Noted - y n ) <br /> Storage Location �S.�� Casing type <br /> Shcrcw/ke �140 <br /> Blank .2 ft. Screen 7, L_ft. <br /> Slot size &,02 V j <br /> GROUTING Bags cement J4 J # Od' ,jT <br /> CG+e s <br /> Depth to water �" / d cna��v(+4b c�sket�s,, <br /> ,emite au <br /> sett g�a a /ee +r-�,er CC�ricsc /, �lqs <br /> Mix Ratios oQA//rnr /4�4 LI-TJ4 CSG Filter Pack type/size_? /Z U <br /> Installation Method Surge Block: - (y <br /> Quantity Installed Discussed with geo gist: - n ) <br /> Type of method <br /> EH 29 29 <br />