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ONITORING WELL INSTALLATION REPO. <br /> Date: 3- .1 I ' _I Z ir6iciW 3.i b .q2 CONSTRUCTION <br /> Premise Address: P)2D-1) C I I1-hC1 Total Depth <br /> �� <br /> VV Screen Length (from) I.S (to) <br /> Well No.: U �' Filter Pack (from) (to) <br /> p A Bentonite (from) I (to) <br /> Inspector: Grout (from) 4 (to)� <br /> Drilling rig type Ac Ke,r A,- - <br /> Permit No. I - U G Auger O.D. 1D" I. <br /> Drilling <br /> W��� ' 1 Z^A�� Completion - Stove pipe/ uistie be (circle one) <br /> Cormpany: 1-t�t '/-'h �" ' <br /> Driller: f✓ddlZ �I�Cy1e�Ih��e� n 1 �l r casing <br /> � � <br /> Consultant PCI(-L(C ILL(y A � \r)A Coroheight <br /> ( d <br /> Geologist I ?gLti Vtl'cnnt -f r lJ _ T <br /> 1 ABOVE-GRCUND 7iFi1STY480X <br /> ronnI.CA COAFLETION CC+i8LMON <br /> SPECIAL PERMIT INFO. Ground Surf <br /> Distance to sewer line 01 <br /> grout <br /> Domestic well on site - y n) <br /> If yes, location and distance - {� I ft. <br /> G R. ft. <br /> MI. <br /> a <br /> SAMPLING clorad = 3 <br /> o 41 n '- <br /> Holding Temperature VW Pack <br /> Method_ yl—I CP LLJ <br /> Screening MethodTracking Sheet - (y/ n <br /> Gtr1o" uacla �vftewc4e h e 14b tt. IF <br /> �� 1t. <br /> WtU runl,A 5�w os-5 <br /> SPOILS 3 t3 `IZ <br /> Storage Method 0f1 � MATERIALS/DEVELOPMENT <br /> Contamination Noted - y n) z vC <br /> Storage Location Casing type `, <br /> K ann ea5FcT& Blank fr. Screen 10 ft. <br /> Slot size0 .02-0 <br /> GROUTING Bags cement b Ln <br /> 1 Buckets bentonite <br /> Depth to water Bags sand/gravel w <br /> Mix RatiosU Filter Pack type/size <br /> Installation Method Surge Block: - ( y n <br /> Quantity Installed 16 q Discussed with geologist: <br /> Type of metliod� 2 t UnEl Of <br /> EH 29 29 <br />