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�.,.JNITORING WELL INSTALLATION REPO <br /> Date: (0 • aq• y3 CONSTRUCTION <br /> Premise Address: y5 E Hn141Total Depth l05 <br /> Screen Length (from) (P (to) :30 <br /> Well No.: M W l Z Filter Pack (from) /05 (to) _ <br /> Bentonite (from) Z8 (to) 2 3 h <br /> Inspector. MfL44 .S Grout (from) ' (to) <br /> Drilling rig type CM <br /> Permit No. 132— ozgb Auger O.D. S" I.D. <br /> Drilling Company: SF, <br /> S Completion - Stove pipe/ deb (circle one) <br /> /� <br /> Driller•. M I P-e D V f casing <br /> F height <br /> Consultant 0 T� V4 <br /> Geologist Ile h7�t i 1 <br /> ABOVE-GROUND p4i15TYBOX <br /> COMPI-��fION COMPLETION <br /> SPECIAL PERMIT INFO. N� Ground Strfan <br /> Distance to sewer line Ill grout <br /> Domestic well on site - (y kM <br /> If yes, location and distance - 2 <br /> M� = a N 4e.� <br /> a Q6 <br /> SAMPLING _I ULt sbtwi = c slo�Ah <br /> GU No d n� aorien r = a6- 7 <br /> Holding Temperature G � o <br /> Method CXUSheCl • I CIL <br /> Screening Method PID <br /> Tracking Sheet • (y/ n)_ <br /> SPOILS <br /> Storage Method div,45 MATERIALS/DEVELOPMENT <br /> Contamination Noted - n <br /> Storage Location Casing type 2�r PVC <br /> L Nv¢Ur-oo Hclydt o- {ivpor+ Blank 7� ft Screen 35 ft. <br /> 5talh to Slot size 2 U <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to ware Z Bags sand/gravel I I 1y5 <br /> Mix Ratios3bckg/ 300Filter Pack type/size <br /> Me3 <br /> Installation thod ' Surge Block: - (y/©) <br /> Quantity installed hA a Discussed with geologist: - O/ n) <br /> Type of method <br /> EH 29 29 V)04<: Ulyped r <br /> X30.93 <br /> Qbd W/ atywf -r ee��re�e r>1lxdUr� <br />