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• PAO .2 OF 3 <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: June 10 T :2,0 S CONSTRUCTION ^' J <br /> — <br /> Premise Address: Z 9 �. re7+ti#� � - Well No. <br /> - d eF rvi 24Y� <br /> Inspector: 1�>C.1L.., ' L � Total Depth 10�i,�f�, e.. a . <br /> rcn <br /> Screen Length 3 . �� <br /> Filter Pack �D ' �'! .27 ✓ '�'hc_�gr.E;a <br /> Bentonite Pellets ..27' - .25' /rrf- In thK , <br /> Permit No. 005' 2 ,198 Grout zs"' <br /> Consultant ^17iP- $ou,^cp. Gram Sn&,. Completion-Stove pipe Christie bo <br /> Geologist Kris4-.ehe- 7idLyk <br /> Auger O.D. <br /> Auger I.D. . ?� <br /> SAMPLING <br /> -41011 - �sticic-up <br /> .ng Temp <br /> Folderature _ <br /> Mthod n I rt-y "j *-h : L � r' <br /> Screening Method A1& ._ <br /> ABOVE-GRCIJND CHAI571, <br /> Tracking Sheet (y/n) <br /> CC&VLrT;ON 'ION <br /> CYpund Surfxe <br /> SPOILS <br /> proof <br /> Storage Method - drpr 2S ft <br /> Contamination Noted - o a/I-3-- h <br /> Storace Location ?�2 c, L .7 9 �— <br /> = a <br /> m <br /> _ o <br /> _ m <br /> SPECIAL PERMIT_ INFO. <br /> �nSNb�®m VG1„N cloned <br /> Distance to P✓ ✓ wc�on <br /> Domestic well on site - (0/no _ Vays�pack <br /> IZ _yes, location & distance - <br /> ti 5Z 4 C'_ <br /> aq.4a = 40 <br /> GROUTING <br /> .L.. MATERIALS USED: �r / <br /> Death to water o�°/ �P� + Casing type c2 1y7-C6 ud�/�/�+�1 T/O <br /> Mix RatiOSnMb Blank £t. Screen <br /> Instillation Method sov4 1''�� Slot size 0. D20 .-.m�i - <br /> Quantity Installed � �4 424 ,ilOJ �av4y,y Baas cement ri �7 Qf-7Y . U.(,4J.6iiA¢. U � <br /> Buckets bentonite lei . piRrfi�. � q <br /> Baas sand/gravel <br /> Filter Pack type/size <br /> 'otal Billed Time Per Site <br /> )ate Perm=t Finalized <br />