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' ONITORING WELL INSTALLATION REPOL'"r <br /> 3Da.h <br /> Date: Y2 L I� ;-70 f S CONSTRUCTION <br /> Premise Address: S c�- � �p r� ,p Total Depth 2 <br /> Screen Length (from) Z (to) 3Z <br /> Well No.: MW - 10 Filter Pack (from) Z (to) 3 <br /> Bentonite (from) 3l (to) 2- <br /> Inspector: Grout MA (from) z8 (to) r ,e <br /> Drilling rig <br /> Permit No. R -* 724 76 Auger O.D. /0-1 &41 I.D. <br /> /� ---� <br /> DrCompletion - Stove pip c istie box' (circle one) <br /> illin�CYmpa� , G��A r,�JJ � I <br /> 1111 Grey 1)--d-&j <br /> Driller: I`Z i r- ti�� Q �s�z.}- casing <br /> height <br /> Consultant �OnQn L�rJ✓ironm�.vfL� r✓��� <br /> Geologist (Tre_g <br /> ABOVE-GROUND <br /> CC MP LET C N <br /> COMPtET1CN <br /> SPECIAL PERMIT INFO. ��'/',y�'� / Ground Surface <br /> Distance to sewer line '"' 6 D 4119aj- -2F,4 grout <br /> Domestic well on site - (y/® 1 4 1 .28 <br /> ft. <br /> If yes, location and distance - I S ' ?,'J 3ft. <br /> Z ft. _ <br /> — m <br /> .?o` = a <br /> SAMPLING j 2. 2- <br /> — <br /> dotted — <br /> Holding Temperature_ �-° aac5on <br /> — <br /> Method Cao lrir f'l� j c-L 37 3,Z <br /> Screening Method <br /> Tracking Sheet <br /> v,- <br /> Sa ja..z___��tt. = z ft. <br /> SPOILS h Id r_47} b�v�ort��c > 30 m;nujej <br /> Storage Method -Irv•yc.j MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/0 <br /> Storage Location_ yS."f� Casing type 4-%,tir sriJ24dyle -4 <br /> Blank_ 3Z ft. Screen <br /> Slot size LD 1, <br /> GROUTING Bags cement Zc <br /> Buckets bentonite U <br /> Depth to water Bas sand/gravel.avel �k C i IO� <br /> g dlgr Eyr � Llro:.tL .► �� <br /> Mix Ratios ? 4.7.' S ..� a2 rreS a L}�..,�Filter Pack type/size A-3 _1 y Iy <br /> Installation Method -� Surge Block: - ( n ) <br /> Quantity Installed 0 �p� _ Discussed with geologist: - ( n ) <br /> �s�e i`yL 4 SS 011" W111-x Type of methodSV{� bji&L- <br /> EH <br /> L <br /> EH 29 29 <br />