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i <br /> NITORING WELL INSTALLATION REPGJ <br /> Date: 12 'q Z CONSTRUCTION <br /> Premise Address: 'l,566 Irk • MUIL, Total Depth 'L3 <br /> Screen Length (from) 23 (to) I'1 <br /> Well No.: F t W ^ '� Filter Pack Mom) (to)- I <br /> Bentonite (from) (to) IAF <br /> Inspector. S. SC� tfL_ Grout <br /> Drilling rig type ER -53 <br /> Permit No. Auger O.D. .'y5 I (0.-z 6; � <br /> Completion - Stove pi dhrisde bo (circle one) <br /> Drilling Company:.. 49C. l3'1.1�W�lA'Jbs�-�- <br /> Driller: (-2At-� casing q <br /> he+ghc <br /> Consultant ✓�[a5wt� ry ' <br /> Geologist_ ►?044 64rIL»�) .- <br /> T <br /> ABOVE-GROUND <br /> COMPLETION n CF6i M-BOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Sutace <br /> i <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ tt <br /> If yes, location and distance - ft. <br /> tt. — <br /> = e <br /> SAMPLING alorad <br /> aodcn '< _ <br /> Holding Temperature 4 C- =_ . <br /> Method lcez Lr%vW Pa <br /> Screening Method p1 <br /> N. <br /> Tracking Sheet - UD( n ) <br /> SPOILS , <br /> Storage Method KS MATERIALS/DEVELOPMENT" <br /> Contamination Noted - (y/Q <br /> Storage Location Quit- 50:e BLKt.t-.o-t4 Casing type 2a dU CL <br /> Blank ft. Screen ft. <br /> Slot size th. 0290 <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water W Bags sand/gravel <br /> Mix Ratios Filter Pack type/size t2. <br /> Installation Method Surge Block: - (y/(" <br /> Quantity Installed Discussed with geologist•. - (y/®) <br /> Type of method <br /> EH 29 29 <br /> k _ <br />