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MONITORING WELL INSTALLATION REPORT <br /> 0 <br /> Gr `.� r� <br /> -Mier - je vej A)e# <br /> Date : iveye rn� eJ 7J7. 70dS CONSTRUCTION <br /> Premise Address : 3141 5 EI DirddG ST' Well No , `/� -,}✓ <br /> Inspector : Vaek , )'Y d 6a rinuq .Total Deoth <br /> Screen Length 3D <br /> Filter Pack 31) , - P ' - <br /> Bentonite Pellets <br /> Permit No .SR. 6) 0 SSG S, Grout Q q0b b44vrpa <br /> consultant l�dygnrr .rt� �r�'e�nth' Vnrrr�O completion-Stove pipe / hristie b�(o <br /> J/1 ' <br /> Geologist d Y112. 1 V ; lihn U2Va, <br /> ?Auger O . D . /d. )zGA <br /> Auger I . D . �n x� q <br /> SAMPLING s. n411 rib <br /> Holding Temperature NA /0 `J/, S � () <br /> Method Al rFl 15' 76;Sr 5*7&.w <br /> (� n 20 zl. S d0jpf <br /> Scraeninc Method W IJI mss ' r >/0j Do 0/)0 .� <br /> 30 - 3/,S , SD °pOmASOVE-GFGUND . <br /> Tracking Sheet � fn ) 'lD) DDlip , CCWL_ET;ON C0MPL='TION <br /> - - C7vund Surixe <br /> S ?OILS <br /> / ,/ 11 grout <br /> Storage Method v � J/h2 G! /" ens `" twj' / < <br /> Contamination Noted - fesno - fl <br /> Storage Location C-flS � tl o n <br /> 5f royCdn IiC o (3for Coyrl , 0 0 <br /> SPECIAL PERM INFO . <br /> slotted _ � <br /> Distance to sewer line 2 <br /> Domestic well on site - yesno <br /> if yes , location & disLtance - <br /> Jtii <br /> f14 [�IF 30 <br /> GROUTING ��11^ GIYCr.{ �Q�/ ,° " • �C� —� b »7� r' U ��S <br /> �f MATERIALS USED :: cC ��11 ' <br /> D to water CID ✓ r`d�W ,j'te' Y I,J Ll-JpFW 3t) Casing type 4 )'L [ / J[ 'lyo'ez;z //,o <br /> M < Rau os_;� r}� rI nil v /v / �n,JBlank� ft Screen :�- 0 t . <br /> ns ' _ lll a mon Method - = Jry A21< " Slot size () 1 i <br /> v er. s : alled Bags cement WI-6 03 iseh' fi � 3arzEC <br /> Buckets bentonite - - Od }W4 ,plug 3� rrchi chips <br /> Baas sand/ gravel Lgp, S 1, SSrr -- J00-Jb bASS _ IG Ixs�s t/Sec <br /> _ _- ter Pack type / siz n Gprojw <br /> btal Billed Time Per Site <br /> ) ate. Permit Finalized <br />