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ONITORING WELL INSTALLATION REPOI0 <br /> Date: Ju n e. G 20 y CONSTRUCTION <br /> Premise Address: Fred Frrti,.r..) e Total Depth 3 <br /> iP rvL l�µrf2r✓%e_¢_. Screen Length (from) 41; ` (to) .2S` <br /> Well No.: C� W Z Filter Pack (from) 3S (to) 23; <br /> �// `, �� Bentonite (from) Z3 (to) 2 / <br /> Inspector. }yj�r /7Sfk, _ Grout (from) 2/ ' (to) SUr <br /> !I Drilling rig type -7)Ty se.,i`[_ <br /> Permit No._ DOS7.3 0 Auger O.D. al I.D. <br /> Completion - Stove pip clu-istie box (circle one) <br /> Drilling Company: W D OL £Jc 21012�i naia <br /> Driller:_ Adm /'/iRoy � casing <br /> height <br /> Consultant -7272- Ssvrw Gje✓-rTn e. . 4 <br /> Geologist <br /> A80VE-GACUND <br /> COMPLETION (99 <br /> COMPLETION <br /> SPECIAL PERMIT INFO. t3rour d Su Lacs <br /> Distance to sewer line ^' S Qrcut <br /> Domestic well on site -L& n ) 1--21—ft. <br /> If yes, location and distance - ft <br /> �o20d �r 23 <br /> ft. <br /> C <br /> SAMPLING <br /> / soc'icn = <br /> Holding Temperature /l/r <br /> Method AM _ <br /> Screening Method_ A) <br /> Tracking Sheet - (y/ n ) A) x, <br /> SPOILS <br /> Storage Method tb n a., MATERIALS/DEVFLOPMENT <br /> Contamination Noted - ( y n II <br /> Storage LocationaP�Y ji! 1 Z IZ24 U fOW� Casing type - I n !M <br /> Blank a 1 ft. Screen_ <br /> Slot size U -n- <br /> GROUTING Bags cement a g- <br /> �� <br /> Buckets bentonite 1 /0 6�y Ie- <br /> Depth to water / Bags sand/gravel- 3 1QU d- B6, �Zc <br /> Mix Ratios Filter Pack type/size '4L-3 <br /> Installation Method I" rU Surge Block: - (y <br /> Quantity Installed ] Discussed with geologist: - ®/ n ) <br /> Type of method <br /> EH 29 29 <br />