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-,cONITORING WELL INSTALLATION REPORT <br /> Date:_�a Zj l L V ` CONSTRUCTION <br /> Ewz tyw3 <br /> Premise Address : L9 ( C� Total Depth T'i7 <br /> Screen Length (from) 4 y (to) _ / ' <br /> Well No. : (= W (rW = Filter Pack (from) v (to) t zj <br /> 1 Bentonite (from) 25 (to) z <br /> Inspector: c( p, y /VL � rCcaueL Grout (from) LC (to) 0 e> <br /> Drilling rig type <br /> j <br /> Permit No, Auger O.D. to " I.D. <br /> nn p 1 1 Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: / � �� ( .r>,.(. � V (�' G�.W�� V( vw�GT <br /> Driller:_ /U'Lt :KLk . V\ casing <br /> A height <br /> / �- <br /> I Consultant (t' IF. <br /> Geologist LL/Li '5 Cr unYc a r <br /> ABOVEGROUND <br /> COMPLETION CNR STY <br /> LET10N <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sew QfOut <br /> Dourest c we on s ' e - ( y n ) z ( ft <br /> If yes, loc on an dist ce - <br /> qqZ3 " ft. <br /> SAMPLING = <br /> alotted _ S <br /> " � � t tac5on = <br /> Holding Temperature lt . c. c�� _ <br /> Method La MA r = V1W pack <br /> Screening Method 1;r, S1,Vg e1v5 <br /> Tracking Sheet - ( y / n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y / n ) <br /> Storage Location Casing type b <br /> Blank -6SZ r{ ft. Screen Co ' ft: <br /> Slot size u • � 3 <br /> GROUTING Bags cement S I5t-ca. <br /> 1 Buckets bentonite T5 M4 <br /> Depth to water Bags sand/grav43JrW R -13r&A <br /> Mix Ratios Q iSa V $ 5 5 t UaL cAswk> Filter Pack type/size <br /> Installation Method `lwsar Surge Block: - ( y / n ) <br /> Quantity Installed Discussed with geologist: - ( y / n ) <br /> Type of method <br /> EH 29 29 <br />