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Nv,.ONITORING WELL INSTALLATION REPC%,W <br /> Date: IZ 1 ' 1 4— CONSTRUCTION <br /> Premise Address: 50 G 0rotcrifi LC L Total Depth tP <br /> �{ `�( Screen Length (from) I (to) <br /> YV 1 ...^ <br /> Well No.: yy Z Filter Pack (from) t(v (to) <br /> Bentonite (from) ;'hZ {to) <br /> Inspector.. U-`f 5 Grout (from) S (to) <br /> "" 32 3 Drilling rig type ,G2.i� <br /> Permit No. Auger O.D. I.D. <br /> �wl Completion - Stove pipe/clu'istie box (circle one) <br /> Drilling Company:��� <br /> Ra LA'1I n -- i-II(� <br /> Driller: •- Wiwn casing <br /> • � <br /> height <br /> Consultant JS l '4 <br /> Geologist K.VOOr–r <br /> ABOVE-GRCUND CHRIS ry-BOX <br /> COMPLETION CaMIPLETICN <br /> SPECIAL PERMIT INFO. Ground Suriacs <br /> Distance to sewer line5 D I KM grout <br /> Domestic well on site - (y n) S <br /> It. <br /> If yes, location and distance - <br /> Ip �. <br /> .� 0 <br /> SAMPLING siot'.od _ <br /> soc len <br /> Holding Temperature� � <br /> Method l L-2 l gravel <br /> Screening Method 1 o FfA'' = <br /> Tracking Sheet - (y/ nIFIF) <br /> ft. tte <br /> SPOILS <br /> J' <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y n !t _PVC <br /> Storage Location 5k (Q Casing type � _ <br /> Blank ft. Screen <br /> Slot size oZ 0 <br /> GROUTING Bags cement <br /> Buckets bentonite V2 u <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method GV'V i Surge Block: - (y n <br /> Quantity Installed Discussed with geo ist: - P�0�fnAType of methode <br /> EH 29 29 ofkh- I vLS-e'a4'*�rl <br />