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MONITORING WELL INSTALLATION REPOR'i <br /> Date: _ td ," CONSTRUCTION <br /> Premise Address: e/�L� TO ,e npf. Total Depth / <br /> Screen Length (from) Ian (to) <br /> Well No.: 1-e12/,Yde:S �� -�� Filter Pack (from) ID< tol J6 21 <br /> ' q I Bentonite (from) ey <br /> inspector. �P.{'AY" neoGrout (from) (to) vr[;a �- <br /> .e <br /> "--�— Drilling rig type w brT�Z <br /> Permit No. S� C r d� D`J Auger O.D. 8 n I.D. <br /> Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company: N� 'IJ 0 �ndt/r-5b alrn4 �sso, -TrRffd'c- <br /> Driller: de anA Ik-SSi�-SSS�hm�l J0 R��—�- casing fit )'7st--b// <br /> ,} 1111 C0YYW5 :Y he_ght sJ <br /> Consultant t ,p ler�zy ^ T <br /> Geologist �AY110,S Rnb%A � ch �:5= ABOyE.GRCUNo T <br /> OON?LETIONGrwrd <br /> Ctvt sTY?pX <br /> SPECIAL PERMIT INFO. Suixr + <br /> gra.: <br /> Distance to sewer line tj A n o(fin <br /> Domestic well on site - (y/ n ) k) W60 9q` $V. t. <br /> If yes, location and distance - I <br /> 1 c/n,6( -Sod <br /> SAMPLING ✓l"�/ 9Icrod <br /> socicn - — <br /> Holding Temperature <br /> Method = <br /> Screening Method _ <br /> Tracking Shcet - (y/ n ) _ <br /> SPOILS 60�( /a te/ - S&A Iw� '�roJ.ur sd&rovkp, lve& <br /> Storage Method jMATERIALS EVELOPMENT .a <br /> Contamination Noted - (y/ n) Casing type 154h i/le- 40 1 y <br /> Storage Location Blank X0 8- ft. Screen—h• <br /> Slot size 0 -0/ l/ <br /> el V'rs o1'`yB��s cement 22.2 'S b4 or-41. <br /> GROUTING <br /> hyd $ <br /> °elF42.5 uacts bentonite a- S-61Yj. H01e 3 df� <br /> Depth to water <br /> 6�r d 7Q e Bags sand/gravel '7 r <br /> Mix Ratios ba# a - �*b -f Filter Pack type�/��' �e lI 3 <br /> 4tstallation Method eajSurge Block: - QV n ) <br /> Quantity lnstalled °7 ✓3 ba�P,/�,e, Discussed vrith geologist. - �/n) <br /> E dltJ �ld f dd df 1�u/i �� /sTypg of methodIUbrr✓C� td d.eagvA�"P�,� If � r?J� <br /> EH 29 29. l <br /> rJt1 2'77� <br /> tiJks cis;-70 <,-L' <br /> A_AJ -J- e 4� X 4r1. Zb '0 <br /> 7 , <br />