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i <br /> MONITORING WELL INSTALLATION RE: _A <br /> I <br /> Date: � l l R CONSTRUCTION <br /> Premise Address : ]3` PJ Total Depth ] 0 3 <br /> Screen Length (from) g 8 (to) `i 8 <br /> Well No. : IM w \ , Filter Pack (from) 23 (to)_ 1 n Z <br /> Bentonite (from) $ L. (to) S 7 <br /> Inspector: Fro4l. (ri �r0-e Grout (from) $ z (to) 4urt4LL . <br /> Drilling rig type lk S A <br /> Permit No. S Ct g g Auger O.D. 09 ` I.D. <br /> Drilling Company: liSI��-C. <br /> Completion - Stove pipe/christie box (circle one) <br /> C1J ✓ti(� � <br /> Driller: \ 0cr-w/ casing <br /> At height <br /> Consultant Jt U U17 <br /> Geologist T1 w. LWT Lk a <br /> ABOVE-GROUND <br /> COMPLETION CHAISiY-Box <br /> SPECIAL PERMIT INFO. pfcund SurfaceCOMPLETION <br /> Distance to sewer line "CXA <br /> Domestic well on site - ( y / n ) F2 • ft <br /> If yes, location and distance - � , ft <br /> SAMPLING <br /> o <br /> slotted ' <br /> wctlon — <br /> Holding Temperature <br /> Method — <br /> Screening Method = _ <br /> Tracking Sheet - ( y / n ) <br /> ft. ft, <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y / n ) <br /> Storage Location Casing type Ry L S� 'tQ _ <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement m& (y °5a q Sa cka ,y0%� <br /> Buckets bentonite 01 S <br /> Depth to water Bags sand/gravel -9 . 13nrp 3 <br /> Mix Ratios_ Scary dtj Filter Pack type/sizQ t' 3 <br /> Installation Method Surge Block: - ( y / n ) <br /> Quantity Installed q6 !Jam Discussed with geologist: - ( y / n ) <br /> Type of method <br /> EH 29 29 <br />