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MONITORING WELL INSTALLATION REPORT <br /> Date: /l01/P CONSTRUCTION <br /> Premise Address: .3 0 R N . 9rd� Total Depth__ '73 -feel <br /> Well No.: - Z Screen Length (from)_ 'R ; (to) S$ ' <br /> Filter Pack (from) 73 (to) 5-? <br /> Bentonite (from)_ s (to) ,S-3 <br /> Inspector. Vj n,kIKf-dgrl-he4) Grout (from) 52 (to) <br /> A A 5�� Drilling rig type C E <br /> Permit No. 44 Auger O.D. /0 Yi-A� Pr I.D. S <br /> ;� <br /> Drilling Company. Completion - Stove pipe/cluisae box (circle one) <br /> �d Sns��� clfo I1 i r�� <br /> Drfller: P/! I En g'l Gt /D✓e cas_n <br /> 14 y P {OYCCo r�. ,ca( Erjn Zoo's 4-W <br /> height 1 <br /> VV <br /> Consultant /j}dv�n�ro �rjt ,/ob/u� 'P <br /> Geologist i � � i` QYYi. Z , J� <br /> ABOVE-GRCUND <br /> OONFLETION (VP <br /> GOti?L-"IICN <br /> SPECIAL PERMIT INFO. 11 �y M mrd Stztacv <br /> Distance to sewer line 700 - 59k'/1,51 it¢- oy1/41; i/' pr•,/; Drat <br /> Domestic well on site S3 It <br /> If yes, location and distance - 5e7 <br /> SAMPLING <br /> a <br /> �Ior.Ai <br /> socicrt Holding Temperature <br /> Method — <br /> > <br /> Screening Method <br /> Tracking Sheet - (y/ n) <br /> Q 3ft. s tt. <br /> SPOILS <br /> Storage Method rS aaz , Mj MATERIALS/DEVELOPMENT <br /> Contamination Noted - (V n) <br /> Storage Location Casing type 41 Y, *6i eve . JA4:"4� <br /> Blank_ Sb fc. Screen fr. <br /> Slot size D <br /> GROUTING h �rJLf� Bags cement ,/ - <br /> �n�SEuckcts bentonite n2", 609U indAlU <br /> Depth to water N Bags sand/gravel �- 4L? ofthe <br /> Mix Ratios i✓.3•rj9�`f/rsLSFilter Pack type/size )q--7 ltri j�G'eiir?e Je <br /> dnstallaaon Method_ /i z0 Surge Block: -W n) S41ze� S6� <br /> Quantity Installed YZ7 Discussed with geologist: - 0s}) <br /> J Type ofnethod sOrea- b/ a�k <br /> EH '2929 C ae&a4J G►/ i`lC �dh //�-�/� 0�S d -41Z, S&Y-/( <br /> �_�__-/I/4✓ • z, Laos, 42e bor,-g 4e)' . 9r�v <br />