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%MONITORING WELL INSTALLATION REPbrfl' <br /> Date: A&ek— /0) L4u9 CONSTRUCTION <br /> Premise Address: LG <br /> _ �/d Al, . 0 Ae y Total Depth 6 <br /> 21- <br /> Well No.: <br /> �/S /( Screen Length (from) (to) <br /> Filter Pack (from) Z (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) <br /> �(to) O <br /> dll0 O D Drilling rig type <br /> Permit No. / 0 Auger O.D. I.D. If <br /> Drilling Company: Completion - Stove pipe/christie box (circle one) <br /> J�-�'� <br /> Driller: � casing <br /> height <br /> Consultant <br /> Geologist (i(Gid <br /> aw-u� T- V <br /> ABOVEGROUND <br /> COMPLF710N CHRJSTY43OX <br /> SPECIAL PERMIT INFO. Ground S�Yy <br /> Distance to sewer line L 5G grout <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - <br /> 59 ft, <br /> 51, m <br /> — o <br /> = e <br /> SAMPLING slottod = ,' c <br /> section — $ <br /> Holding Temperature <br /> Method g"�pack <br /> Screening Method _ <br /> Tracking Sheet - (y/n ) <br /> O ft. — ---2r ft. <br /> SPOILS <br /> Storage Method_ :55 22-k We-R-. kw-Q MATERIALS/DEVELOPMENT <br /> Contamination Noted - Cy/ n ) , <br /> Storage Location Casing type Z 3Ck Py� <br /> Blank ft. Screen 2y ft. <br /> Slot size . o2-0 " <br /> GROUTING Bags cement % 10 4 <br /> Buckets bentonite 06-460 <br /> Depth to water Bags sand/gravel <br /> Mix Ratios 4 k. w t 30 Filter Pack type/size 3 <br /> Installation Method Zix'�A Surge Block: - (y/n) <br /> Quantity Installed '1 9C* Q4� Discussed with geologist: - (y/n ) <br /> Type of method <br /> EH 29 29 <br /> 31% <br />