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MONITORING WELL INSTALLATION REPT <br /> Date: 5' 9 9 / CONSTRUCTION <br /> Premise Address: g2 U3 5. / Total Depth 20- 0 / <br /> Screen Length (from) 9-6, 0 (to) 5 <br /> Well No.: a zJ Filter Pack (from) (to)� <br /> Bentonite (from)--' (to) 3.5 <br /> Inspector: S• GC4q1,jtn bo?— Grout (from) S (to) ' <br /> Drilling rig type CHCS' <br /> Permit No. Auger O.D. 2 [ S <br /> Completion -Stove pip Christie bo (circle one) <br /> Consultant 1,�ttiGC, L��t2a�MWJ4}�(, E��oU-P <br /> Geologist 'tILL02il, tzAO stldaoP <br /> SPECIAL PERMIT INFO. ABOVE-GROUND <br /> Distance to sewer line <br /> y / OOMPLEfION COMPLETION <br /> Domestic well on site - & n ) �S` °o� 7 — <br /> [f yes, location and distance - grout <br /> - wAv.-rL /s o tL!y usw) To f:;wstZ <br /> y!•lsc Totuc7, ihaayG 04t-i oU aW4u5 4rSouWea- tt. <br /> n. <br /> RC. <br /> SAMPLINGC' <br /> Holding Temperature °� &loud <br /> Method C 0- f uCSon _ <br /> Screening Method 9R�W pack <br /> Tracking Sheet - n) <br /> 5S: _ <br /> SPOILS <br /> Storage Method Z- MATERIALS/DEVELOPMENT <br /> Contamination Notes - 1(vY n ) <br /> Storage Location 6/T(s Casing type _ St's QC) R/C 3 <br /> Blank ft Screen )5 ft. <br /> Slot size D. D20 <br /> Bags cement <br /> GROUTING Buckets bentonite *&""br <br /> Bags sand/gravel <br /> Depth to water Filter Pack type/size 4t.;La- <br /> Mix Ratios / 11 ��1✓/5 06"&4 5"—WeV Surge Block: - (y n ) <br /> Installation Method Aralu- Discussed with geologist: - (y/ t� <br /> Quantity Installed Type of method <br />