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_ .ONITORING WELL INSTALLATION REPOk , <br /> M <br /> Date : _ t J CONSTRUCTION <br /> Premise Address : Oz�\CA4 D Total Depth LSO <br /> Screen Length (from) Oro (to) 7v ' <br /> Well No. : iA L, � 75 Filter Pack (from) AU (to) 1 d 1 <br /> �P Bentonite (from) � . $ (to) L t <br /> Inspector: ;�U r� f/T T Lr-tel Grout (from) <br /> Drilling rig type <br /> Permit No. (Z/� () u U ppJ Auger O.D. $ ' 4 I.D. <br /> L <br /> W,� GvW AA> wAiv+ Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: � G L <br /> Driller: At ( In�YL.u - N 7AW "k kAl —i— casing <br /> height <br /> Consultant �'�'i <br /> Geologist [,"15 <br /> ABOVE-GROUND <br /> COMPLETION 4 <br /> SPECIAL PERMIT INFO. O=nd SurfCOMPLETION� <br /> Distance to sewer line proof <br /> omestic we site - ( y / n ) <br /> I yes, loc on an distance - It <br /> ft. <br /> a <br /> SAMPLING <br /> Slotted = c <br /> serion <br /> Holding Temperature _ P <br /> Method Z(mL <br /> Screening Method <br /> Tracking Sheet - ( y / n <br /> I F ft. <br /> SPOILS aa <br /> Storage Method 5 5 'tical 174-Ww MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y / ) <br /> Storage Location M 5 4Casing type_ o �7 U L <br /> aI l, Iys • ZS- 3 > ' Blank -tn7 fr. Screen <br /> Slot size O _ d"L <br /> GROUTING Bags cement 14 ` <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size L LIZ <br /> Installation Method " AA^ v Surge Block: - ( y / n ) <br /> Quantity Installed Discussed with geologist: - ( y / n ) <br /> Type of method <br /> EH 29 29 <br /> { <br />