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ONITORING WELL INSTALLATION REPOi . - ' <br /> nd <br /> I �y ' / <br /> Date: I �10ve »-tbeY .Zfi 2'W CONSTRUCTION dn� ✓��l'� ) a� �/� � )d <br /> Premise Address :_ 31 + 7 S . Et J)C) " dn aST, Total Depth qV 0 <br /> P <br /> I Screen Length (from) 0 (to) 10 <br /> Well No. : I-' Filter Pack (from) D (to) <br /> Bentonite (from) 9 ` (to)4 <br /> Inspector: Vllk ; NL44 YGrout <br /> (from) /. � (to) .SUf tet- <br /> Drilling rig type <br /> Permit No. 00 G 3 A 1 Auger O.D. g ' aL /D " r I.D. 2f OL G , aS <br /> nJ Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: All Ze/1 rf,bangbm ter/& <br /> Driller: M'Q UA I 4YI JpsL �elCf casing <br /> �J height <br /> Consultant <br /> Geologist <br /> ABOVE-GROUND <br /> COMPLETION 7to <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer linegrout <br /> Domestic well on site - ( y <br /> If yes, location and distance - —i—a ft. <br /> I U ft t14 <br /> a <br /> SAMPLING ebtted g <br /> Q W) U. wc5an - _ <br /> Holding Temperature G = <br /> Method ^ D o. 7 <br /> F = gnvdpack <br /> PA = <br /> Screening Method D 2. 3 . <br /> Tracking Sheet - / n ) <br /> ft. D ft, <br /> SPOILS <br /> Storage Method SS,6/J,,,_—et/rri / MATERIALS/DEVELOP NT <br /> Contamination Noted - Q y n ) <br /> Storage Location_ lyi r n ,c { Q Casing type 9dj144&4:- 1/D Pye- <br /> Blank / 0 ft. Screen 30 ft. <br /> Slot size <br /> GROUTING Bags cement a % bags RI /d ) 15AP-le p r fly <br /> Buckets bentonite �' vlv,„ 5 Iar <br /> Depth to water Bags sand/gravel MS / - , <br /> Mix Ratios / o 11,".s f der 1'Z6 ;F, <br /> m�n1 Filter Pack type/s 'ze '4 3 f <br /> installat on Method ae� a /ry Surge Block: - (�/ n ) f <br /> Quantity Installed / ba ile2t- Discussed with geologist: - y n ) <br /> EH 29 29 Type of method Sit <br />