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•MONITORING WELL INSTALLATION RIPIRT <br /> 17,e 4- kft,,A%� I&Icd i15ve t lo-1 prob441- �wuus�vl�� <br /> jM fcYJSb"(/ gA, /err 31.+t 4 jr w�!( aj/ Sec7 S��Gal <br /> t'ee's` SG��`�-f�Sc%e.( af- itJ.-Y dv6r.- tc 'r sets,- <br /> �cw �CV yl� Fj Sk.TI ��ev`( �� boles <br /> Date: y� g CONSTRUCTION <br /> Premise Address: I WJ✓e G`LVeaslil. Total Depth <br /> r o Qe� 3k/8�S ti(„ 3 f Screen Length (from) 37 s (to) 32 <br /> Well No.: 5 Q I Filter Pack (from) 37. 5— (to) 30 <br /> J Bentonite (from) Fr (to) 3 U <br /> Inspector: �Q��f/ Grout (from) (to) Z� ` <br /> S 12 D d S� 3 Z 3 Drilling rig type <br /> Permit No. Auger O.D. 1W51�,/I I.D. 5 ' <br /> Completion- Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: L,14e- casing <br /> ,.,`�� ( � � height <br /> Consultant <br /> —QV-f <br /> Geologist �Zr�/i " •- <br /> ABOVE-GROUND CtffiiSTY BOX <br /> COMfPLEfION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surfxw <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - ft' <br /> ft. <br /> ft. <br /> = m <br /> — n <br /> = m <br /> = c <br /> SAMPLING slotted _ 8 <br /> section <br /> Holding Temperature <br /> Method = P <br /> Screening Method <br /> Tracking Sheet - ( y/n ) <br /> SPOILS /ABY a4 Gr/S'k)7aZ h0ll"3 f /� <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel 911/. l� <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 J� Z74 <br /> A4111 /ytpl/ IOA4 bk Ro%�t�n rcl <br />