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MONITORING WELL INSTALLATION REPO <br /> Date: I o-3-Z o J y CONSTRUCTION <br /> Premise Address: I6co w. DgR44M fE%Ly Ski TMW' Total Depth io FEEr <br /> Screen Length (from)— _(to) 10 , <br /> Well No.: VEvJ-3 -r"-,jVbvJ'6 Filter Pack (from)' TT—(to) 10 , <br /> Bentonite (from) 2-' (to) 9•5 <br /> Inspector: - -VP*KL4W Grout (from) s�c�4cE (to) <br /> w 2 <br /> Drilling rig type NFlA� <br /> Permit No. 5oZO07b SO Auger O.D. 9" I.D. N/Fl <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: v4vj DQ'"1-6 6V-ouY To 5j0ftE <br /> fPA^ K �2q^^E8+2 casing <br /> Driller: <br /> ITTI <br /> height <br /> Consultant (�RO`Ov -Zr-,"— f oWSiS �^,G• <br /> Geologist A'jDR£w C)'f <br /> ABOVE-GROUND CHRISTY-BOX <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Gmund S�'� + � <br /> N o ;"v- grout <br /> Distance to sewer line 1 <br /> Domestic well on site - n) L_fl. <br /> If yes, location and distance - EgST ft <br /> � lzs <br /> m <br /> C <br /> y <br /> SAMPLING slottsod <br /> section <br /> e <br /> Holding Temperature M L = Gn Bl P <br /> Metho Mk <br /> Screening Method v: _ <br /> Tracking Sheet - ( n ) _ <br /> SPOILS <br /> Storage Method SS-bA'-LoN RANI MATERIALS/DEVELOPMENT <br /> Contamination Noted - j y n) <br /> Storage Location oN-S.TC Casing type PdG <br /> Blank—RLS'—ft- Screen 5 � ft. <br /> Slot size 0-07- <br /> GROUTING <br /> -ozGROUTING \ Bags cement < <br /> Buckets bentonite < I <br /> Depth to water r I P, Bags sand/gravel < <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/n <br /> Quantity Installed Discussed with geologist: - (y/ n) <br /> Type of method <br /> EH 29 29 <br />