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y ; <br /> r <br /> MONITORING WELL INSTALLATION REPGD <br /> ii <br /> �j <br /> Date 12 r{ • Q 2 CONSTRUCTION <br />� � 1 � l <br /> Premise Address: 3555 6), vaetmvvv,44_ Total Depth 'LI •� <br /> Well No.:_ f dd,.J -Lo Screen Length (from) (to) t <br /> Filter Pack (from) V -'5 .(to) 14 <br /> Bentonite (from) 14• (to) 13 <br /> Inspector: Grout (from) 13 <br /> Drilling rig type <br /> Permit No. �2 - 3$�3 Auger O.D. -9-2-6- I.D. <br /> nn <br /> Drilling Company: Completion - Stove pip Chris a box ircle one) <br /> I'C li '� <br /> i <br /> Driller:_ _ N�Y�y,71� casing I <br /> Consultant �StJRr• height " <br /> Geologist alQk & t A-1,I <br /> ABOVE-GACUND <br /> OOMPLETION poi M-80X <br /> CCMPLEnON <br /> SPECIAL PERMIT INFO. Ground Susfxv <br /> Distance to sewer line grout <br /> Domestic well on site - (y/(15) ft. <br /> If yes, location and distance - fL <br /> ft. <br /> wq• - m <br /> SAMPLING <br /> glorsd — <br /> socicn — 8 <br /> Holding Temperature_ °G _ {�� <br /> Method lC 5' ;4'6 = . r <br /> Screening Method LOIS - <br /> Tracking Sheet n ) - — <br /> SPOILS d <br /> Storage Method 11.24'As MATERIALS/DEVELOPMENT <br /> Contamination Noted • (y <br /> Storage Location QUA V- to P-tWLj71.w4 Casing type 2° PYG <br /> Blank ft. Screen ft. <br /> Slot size C>•o Zo <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water l t Bags sand/gravel <br /> Mix Ratios Filter Pack type/size )Z <br /> Installation Method Surge Block: - ( y/®) <br /> Quantity Installed Discussed with geologist: - (y/(2C3 <br /> Type of method <br /> EH 29 29 <br /> i. <br /> i <br />