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MONITORING WELL INSTALLATION REPC,„o� <br /> q� Se e. � ��.� C � <br /> Date: �/a O L CONSTRUCTION <br /> Premise Address;`-"zOa tt4A'c- Z1;,VO'1 P Lt Total Depth 70 <br /> #� <br /> U/ Screen Length (from) 70 (to) <br /> Well No.: At Z Filter Pack (from) r o (to) <br /> Bentonite (from) q-c-- (to)q7 <br /> Inspector. e� Grout (from) _V (to) eo <br /> Drilling rig type S <br /> Permit No. qz �2�� Auger O.D. 10" I.D. 10 9y" <br /> P�/ „c Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company:(_ tL1a( <br /> Driller: \ �.v casing, <br /> / height <br /> Consultant <br /> Geologist_ _Z)'-uM <br /> ABOVE-GRCUND CHRZTY-BOX <br /> COWLETION COMPLETION <br /> SPECIAL PERMIT INFO. C3round SuAan <br /> Distance to sewer line gfout <br /> L 2 / <br /> Domestic well on site - (y <br /> If yes, location and distance - ft. <br /> SO ft. — <br /> .. <br /> SAMPLING <br /> slotted = <br /> /o S4 saricn <br /> Holding TepEerature <br /> Method .0 -Z z 7 A „ iE <br /> Screening Method /1/0 <br /> G� <br /> Tracking Sheet -g/ n ) 6 <br /> 'l0 170 ft. __. = 170 tt. <br /> SPOILS <br /> Storage Method �^ � !. MATERIALS/DEVELOPMENTContamination Noted - y n ) „ <br /> Storage Location A c E Casing type t{ PU C. <br /> Blank SO ft. Screen__7 o ft. <br /> Slot size Al D <br /> GROUTTNG Bags cemen�s/-6 <br /> Buckets bentonite l Sc:f <br /> Depth to water C-7 .76 Bags sand/gravel <br /> Mix Ratios r-g l Filter Pack type/size <br /> Installation Method /�A�--�k Surge Block: - (y/ n <br /> Quantity Installed /C n, .-e Discussed with geologist: - n) <br /> Type of method <br /> EH 29 29 <br />