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t <br /> %w3NITORING WELL INSTALLATION REPC,, <br /> Date: q'"1 CONSTRUCTION <br /> Premise Address: Total Depth <br /> r,l M f Screen Length (from) _(t } <br /> Well No.: vV Y� Filter Pack (from) (t <br /> Ins ecton Bentonite (from) (to) <br /> P Grout (from) (to) <br /> o�b Drilling rig type <br /> Permit No. Auger O.D. - I.D. =Z <br /> / <br /> Drilling Company: Completion - Stove pip uzs a ox ircle one) <br /> � <br /> Driller: casing <br /> height <br /> Consultant <br /> T 1 <br /> Geologist <br /> /IBCVE-GRO(JND CHRM'TY480X <br /> AA�� r�' ����r COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. lulw`'I I' o* �,nd Suface �„�....., <br /> Distance to sewer line grout <br /> Domestic well on site -CY1 nS+{.9 �3�g <br /> { <br /> If yes, location and distance - `�-� q-- � 8-Ca /Z it. <br /> Wat <br /> SAMPLING d Si t (5 Z3 alorai — c <br /> Ni <br /> socicn = <br /> Holding Temperature ur-+- �~ <br /> Method - —_ " F <br /> ack <br /> Screening Method <br /> Tracking Sheet y' n) f � =_ <br /> SPOILS <br /> Storage-Method 'U'l (l_ MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y14 <br /> Storage Location On,6 Casing type <br /> Blank `7' ft. Screen )5 ft. <br /> Slot size <br /> GROUTING Bags cement 5 b 7 + <br /> Buckets bentonite — 5 <br /> Depth to water_ g Bags sand/gravel /2 <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/ i ) <br /> Quantity Installed �`"' Nwr. Discussed with geo gist: -d/ n ) <br /> •� <br /> EH 29 29 Type of method <br /> �_ <br /> 1\o�e. µwLt 1ac.._-+Cb VWq-'X" RrWvw. " <br /> j,2CGvSe 11-e may'- <br /> rid <br /> dtscxsl �� �- {-crw�ui4 <br />