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MONITORING WELL INSTALLATION RECORD <br /> TETRA•TECH EM INC. FLUSH MOUNT INSTALLATION <br /> I <br /> .L LOCATION INFORMATION COVER <br /> WELL NO. WELL CAP <br /> BOREHOLE NO, L��lr�-p�� HEIGHT OF WELL CASING <br /> SITE NGS ELEVATION TOC <br /> SUBSITE GROUND <br /> •DATEZ5 ELEVATION <br /> RECORDED BY <br /> WELL PERMIT NO. <br /> SLOPED CONCRETE PAD/SURFACE SEAL <br /> SURFACE COMPLETION INFORMATION GROUr,. <br /> TYPE OF INSTALLATION DEPTH 7o TOP OF GROUT Sv <br /> p OPEN HOLE ❑GROUT FORMULA(PROPORTION CH) <br /> INSIDE HOLLOW'STEM AUGER CEMENT.L00(W.ENTONITE <br /> WATER OTHER <br /> TYPE OF FLUSH MOUNT QUANTITY Us D <br /> t&CHRISTY BOX E]PREPARED MlX <br /> D -NAME OF PRODUCT <br /> Cl LOCKING COVER MANUFACTURED BY <br /> -,p WATERTIGHT CAP QUANTITY USED <br /> $LOCKINGCAP TYPE OF CASING <br /> SURFACE SEAL (]STAINLESS STEEL CASING DIAMETER <br /> p NON-SHRINKING CEMENT ®SCHEDULE 0 PVC INSIDE <br /> 8 <br /> D SCHEDULE 80 PVC OUTSIDE _ Z ivy_ <br /> .g CONCRETE - <br /> O ❑MANUFACTURED BYy4u <br /> []*CHECKED FOR SETTLEMENT DEPTH TO TOP OF BENTONITE SEAL <br /> ❑ INTERNAL MORTAR ADDED BENTONITE SEAL J•PELLETS ❑SLURRY <br /> p POWDER/GRANULAR ❑ <br /> f ;ROUND SURFACE ELEVATION QUANTITY USED <br /> d SURVEYED DEPTH TO TOP OF METHOD INSTALLED " <br /> DATE FINE SAND COLLA ❑TREMIE CI <br /> �D POURED ❑NOT USED <br /> MEASURING POINT <br /> ❑70P of WELL CASING FINE SAND COLLAR(OPTIONAL) <br /> DEPTH TO TOP OF SIZE/TYPE <br /> ❑GROUND SURFACE FILTER PACK <br /> ❑ FILTER PACK <br /> DEPTH TO TOP OF GRAVEL SIZE• TO F7. <br /> SAND SIZE IL 3 70 10 FT. <br /> DRILLING INFORMATION SCREEN QUANTITY USED <br /> DRILL NG COMP NY/PERSONNEL FORMATION COLLAPSE; To FT. <br /> / MATERIAL ' <br /> METHOD INSTALLED <br /> TREMIE <br /> DRILL RIG t�V_r 5 POURED <br /> CENTRALIZERS <br /> DRILLING METHOD E]YES AT GRAIN SIZE TESTS FOR FILTER PACK <br /> •p HOLLOWSTEM AUGER '• p CONDUCTED;FOR REPORT,REFER TO <br /> [I AIR ROTARY []STAINLESS STEEL [ANOT CONDUCTED <br /> ❑MUD/WATER ROTARY ❑ TYPE OF SCREEN <br /> (] �9 NO []STAINLESS STEEL SCREEN DIAMETER <br /> DRILLING BEG Ph DEPTH TO BOTTOM �]SCHEDULE a0 PVC INSIDE <br /> BATE 8 Z5 `6TIME — �OF SCREEN •; SCHEDULE 80 PVC •OUTSIDE <br /> WELL CO PL TION BEGAN DEPTH TO BOTTOM ❑SLOT SIZE <br /> DATE `S TIME 5 F" ilOp-la OF CASING MANUFACTURED BY <br /> WELL COMPLETION FINISHED DEPTH TO BOTTOM <br /> DATE -8Iz6/5fsrIME 730 hK FILTER PACK ♦ BACKFILL MATERIAL <br /> DRILLING FLUID TYPE �III_III—. <br /> [I GRAVEL 0FORMATIONCOLLAPSE <br /> ❑BENTONITE ❑WATER DEPTH TO BOTTOM .rl I I []SAND NITS MATERIAL <br /> []POLYMER ❑ — Ifb OF BORING "/ ❑ <br /> DRILLING FLUID LOSS <br /> ❑YES GALLONS CASING AND SCREEN LENGTH OF 10 <br /> � AT NO NOTES: <br /> WATER ADDED DURING COMPLETION DEPTH TO WATER 1•SCALE:NONE <br /> []YES GALLONS FOLLOWING 2.RECORD DEPTHSILENGTHS IN TENTHS <br /> NO INSTALLATION (TOC) :' OF FEET,NOT IN INCHES <br /> TfA 7AL FLUID LOSS 70 FORMATION - 3.RECORD CONSTRUCTION DEPTHS <br /> BELOW GROUND LEVELe n�Q� 4078 <br /> GALLONS DIAMETER OF BOREHOLES --- 14Ff1RA1SUNSTF.L �rL�Y oI a. e <br />