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ONITORING WELL INSTALLATION REPO* <br /> Date: 3 '��' r1 CONSTRUCTION <br /> Premise Address: 'E2`1,; L , 1 1`A, -Izlv, Total Depth f <br /> Screen Length (from) F— (to <br /> Well No.: /L '`/ Filter Pack (from) (to) <br /> Bentonite (from) S (to)--- <br /> J <br /> Inspector. Grout (from) (to) �i- <br /> Drilling rig type <br /> Permit No. 3 Z Auger O.D. /C <br /> Completion - Stove pip tristie >ox (c cle one) <br /> Drilling Company: ���5 T ifn�M-.moi <br /> Driller: C�E1c /S1ll�Jc^ casing <br /> height <br /> Consultant �>�KL �1.11(120r,11't�STYL_, Cy.� <br /> Geologist T1 H ici top/ <br /> ABOVE-GACUND <br /> COWLETION CH8ISTY480X <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Sufaos <br /> i <br /> Distance to sewer line `� _ grout <br /> Domestic well on site - L7 in <br /> If yes, location and distance - ft. <br /> 0 <br /> SAMPLING = -° <br /> sodCn <br /> Holding Temperature 40 <br /> Method ; <br /> Screening Method l 4c <br /> Tracking Sheet - (y/ in _ <br /> 1t. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y ) <br /> Storage Location_ ck 7?Z Casing type 3 � 5Lv{ }�` l-/e— <br /> Blank >> ft. Screen /U ft. <br /> Slot size <br /> GROUTING Bags cement_ RCS S <br /> n Buckets bentonite <br /> Depth to water b•3 Bags sand/gravel <br /> Mix Ratios 7/fir 4 i-)tiyv 4 i Filter Pack type/size f1 <br /> Installation Method� T�;�> ��2 Surge Block: - ( y/�nj <br /> Quantity Installed 3 /;-4 S Discussed with geologist: - V n ) <br /> Type of method Ys <br /> EH 29 29 <br />