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MONITORING WELL INSTALLATION REPS-'T <br /> Date:ly Z -6 l of!K CONSTRUCTION <br /> Premise Address: Z Osumhal Total Depth (nb` <br /> Screen Length (from) y.se S-.(to) 4 ZS <br /> Well No.: A Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: �)�ndtC y r 1_ Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. <br /> Completion- Stove pipe/ tie bo (circle one) <br /> Drilling Company d <br /> Driller: 0 Pk L^ ln1A )PJ �Dwlr( casing <br /> n height <br /> Consultant c nntin u�.0 ..r —QW-F <br /> Geologist l i Unit t!�oj= •� <br /> �80YE-GFiOUND GiFitSfY-SOX <br /> COMPL.ErON COMPLE770N <br /> SPECIAL PERMIT INFO. Grourd Suiact <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n <br /> If yes, location and distance - ' . <br /> q <br /> - C <br /> — a <br /> SAMPLING slotted <br /> Holding Temperature <br /> Padc <br /> Method — <br /> Screening Method „ <br /> In cLt- <br /> Tracking Sheet - (Q/n) 1 <br /> `A S'1 y. <br /> I F tt. <br /> SPOILS <br /> Storage Method o MATERIALS/DEVELOPMENT <br /> Contamination Noted - n ) <br /> Storage Location Casing type L.- L <br /> Blank K6•S it. Screen <br /> Slot size . O 1L <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Y,,, 350' Bags sand/gravel� <br /> Mix Ratios -S -11 U, brA CaMUMA Filter Pack type/size ad <br /> Installation Method Surge Block: - (y/0) <br /> Quantity Installed Discussed with geologist: - (y <br /> Type of method <br /> EH 29 29 <br />