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' � � �, -.. ���^_ motif- - " t �, � � . , .�..- '• fl r } <br /> - <br /> p MONITORING;WELL INSTALL--.ATION-REPO i <br /> Date: 30 "" CONSTRUCTION <br /> i <br /> Premise Address: C7 �� ✓�" t�� <br /> (Total De th <br /> , P <br /> (a5+ I (,Scen Length (from) Z %z <br /> re (to).- <br /> Well No.: r, '� � .' 4 FiliWPack '''(from) -- Zy %.T`(to) -- q IrA . <br /> ! Bentonite f (from) <br /> Inspector: r Meas ;# Grout (from)__ 43iz �' (to) <br /> Drilling rig type <br /> Permit No. G[- o go _. , Auger O.D. -,{*" T.D.' `y j:�'' _ <br /> ! Completion Stove pipe/chnstie.box -(circle one)t <br /> Consultant �r b G n��e"ra T� y � <br /> Geologist 11Jljtlav� � fl� P#� -up loeU+ujGP <br /> SPECIAL PERMIT INFO. : .. �.J� i <br /> ~ COMPLETION G iRlS7Y-80X <br /> Distance to sewer line - COMPLETION i <br /> Domestic well on site - ( y/ham 5'�°0e <br /> , <br /> If yes, location and distance <br /> 9fout <br /> �- <br /> SAMPLING do <br /> _ <br /> Holding Temperature <br /> erature <br /> sardan ~` <br /> E Method f k A; — <br /> Screening Method PCOfflrd ", 1 t . ' �!phi <br /> Tracking Sheet 4--On — <br /> # } } (--P� w P-SU <br /> p'r V,-C -C.•rS}�r!OPL 4�{ � 5: c y .' •� s /�"YY- M.L <br /> SPOILS <br /> 1� <br /> g p1z5-I-tc� Gave �, <br /> �Stora a Method�+��"�R �_. _ Y'�'-Gl - MATERIALS/DEVELOPMENT <br /> Contamination Note- (y D V <br /> ! Storage Location-:. '0— Casing type VC �rJ G - _ <br /> Blank ft. Screen' Zo ft. <br /> Slot size_. O. !�2 I L2 <br /> Bags cement 3-L4 <br /> GROUPING , , �. ., Buckets bentonite ! - ' b r1 c <br /> E �+� ' f # `�� I - <br /> Bags sand/gravel roA <br /> Depth to water , ! - Filter Pack.type/size 2 <br /> Mix Ratios'r" i r - x�: ,, ` <br /> Surge Block: - (y Rzist: <br /> Installation Method_ -, ` " "'Discussed with geo - n ) h <br /> Quantity Installed A 1 rrt� Type of method <br />