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10 <br /> 0 SONITORING WELL INSTALLATIONi <br /> P <br /> Date: 12.I l> ( ,> C, CONSTRUCTION <br /> y�2�u>�cta�- // <br /> Premise Address: Z3 Total Depth b� <br /> _ Screen Length (from) 52 (to) G� <br /> Well No.: IJ✓l - 5 Filter Pack (from) 5b (to) <br /> 1' ll Bentonite (from) 70 (to) 4 8 <br /> Inspector: V `rttW�-' �rlrows t Grout (from) 12 (to) q 8 <br /> Drilling rig type t14A <br /> Permit No. -7 rj* 53 Auger O.D. > I.D. <br /> Completion - Stove pipe/ she ox (circle one) <br /> Drilling Company: � s`(�SS, p7ti��1W"� , <br /> Driller: <.t-C--' casing <br /> rr height <br /> Consultant ��r� WT <br /> Geologist _D4wf ABOVEGROUND <br /> COMPLETION COCOMPLETION <br /> SPECIAL PERMIT INFO. Ground S <br /> Distance to sewer line Rz <br /> grout <br /> Domestic well on site - (y/ n ) 1 y� ft <br /> If yes, location and distance - R 501 n. <br /> = m <br /> N <br /> 9 <br /> C <br /> O <br /> SAMPLING slottad = 8 <br /> tecion <br /> Holding Temperature 1Na 5 _ graviA Pack <br /> Method ' _ <br /> Screening Method = <br /> Tracking Sheet - (y/ n ) <br /> L n. <br /> SPOILS <br /> Storage Method_ YS �7rw✓� MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) - <br /> Storage Location Casing type L"GaS� <br /> Blank 1'IF ft. Screen--j �ft. <br /> Slot size 0w <br /> GROUTING Bags cement /S•b cw,rt- <br /> Buckets bentonite OVI-41 <br /> Depth to water Bags sand/gravel q t <br /> Mix Ratios 62" Filter Pack type/size �3 <br /> Installation Method Surge Block: - ( y/ n ) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br /> 11.11/NI M / " `' �I <br />