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MONITORING WELL INSTALLATION REPOrLT <br /> Dater 3 ' d Y 9 S CONSTRUCTION <br /> Premise Address: !o !o ti' Nu ck? r S//cam ' Total Depth q <br /> Screen Length (from) L/1 ' (to) a <br /> Well No.: t77 /a s Filter Pack (from) y i � (to) ! 4 <br /> Bentonite (from) / 7 (to) <br /> Inspector: e? . 0z Grout (from) / '7 ' (to) c �Q <br /> Drilling rig type_ //o //, w s Je <br /> Permit No. Auger O.D._A %v " I.D. /o ' <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: V * w 7�-f - a7y -38ls <br /> Driller: Lu w y d /e casing <br /> height <br /> Consultant--.9 7 (' A ss c r <br /> 7vm <br /> GeologistF.i� LuflL� r� �cH <br /> ABCVE�ACUND CHS <br /> OC&PLErION t CN <br /> SPECIAL PERMIT INFO, GO"rAd Ste"' T� <br /> Distance to sewer line prI <br /> Domestic well on site - ( y ,{� ) t 7 r •if yes, location and distance - 73 <br /> I <br /> SAWUNG slotted = c <br /> urian <br /> Holding Temperature 66 N _ _ 72%*W Pack <br /> Method <br /> Screening Method P/O = <br /> Tracking Sheet - ( }� n ) — <br /> s ��ySu ^ - � @ ate ' � � � _ ♦ Let fL <br /> SPOILS <br /> Storage Method 5 ' �� `N' MATERIAI..S/DEVELOPMENT <br /> Contamination Noted - UP, n } <br /> Ze <br /> Storage Location GK r fo Casing type PYG a <br /> Blank a—r fL Screen 27 fL <br /> Slot size : cx7 0 <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water :y ' ff S Bags sand/gravel (`/i r <br /> Mix Ratios / S Filter Pack type/size8 <br /> InstallatioSurge Block: - (©' n ) <br /> Quantity Installed Discussed with geologist• - T n ) <br /> Type of method o� �/ ma u p <br /> EH 29 29 <br />