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MONITORING WELL INSTALLATION REP ' <br /> J y <br /> VU <br /> __ 2 � _ <br /> Date: 4 f r [ CONSTRUCTION k <br /> �/ <br /> Premise Address: o Total Depth <br /> Screen Length (from) Z t (to) b <br /> F _ <br /> Well.No.: 2 3 ".'W', ) Filter Pack (from) (to) <br /> [ ,y Bentonite (from) (to) <br /> JIspector !/" v( I Grout (from) 3 (to) 0 <br /> n -' 010 ro r Drilling rig type 5757 <br /> Permit No. a Auger O.D. g,, I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> is 6 <br /> Drilling Company*_ �r�� <br /> Driller t ;�� / ''` �' casing <br /> height <br /> Consultant <br /> 1 Geologist <br /> nn i� /18OV>r-rF�aJIVt} C,NR9.S1Y-80?C <br /> A&W"3 W 9x • (�.a� cow DoH Lzn0N <br /> SPECIAL PERMIT INFO. Ground S�� <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - (y/ � _ft. <br /> if yes, location and distant l�U? <br /> �V 0j <br /> slattad .: i <br /> SAMPLING <br /> v � socdon <br /> Holding Temperature = Bawl Park . <br /> Method _3 <br /> Screening Method l E �5 �o wlrlw 1 _ 1014 <br /> Tracking Sheet - (y/ n) = Z f 5 <br /> / A'to�4 clayey y tt. _ ` ti. <br /> CA <br /> SPOILS C00.rS9c� `re <br /> rnn� <br /> ' <br /> Storage Method Sl� 1Yc�m-- C`may MATEgJpLS/DEVELOPMENT t 02A <br /> Contamination Noted - (y <br /> Storage Lo ation / Casing type <br /> ! J ft. Scren ft• <br /> wn<C� So,� "4a �o)Blank <br /> SI <br /> ot size , 010 <br /> GROUTI Y z w �� `( -f o7u�vra"`' Bags cement <br /> Buckets bentonite <br /> Depth to water N Y Sak�ra�i Bags sand/gravel Z 1 y <br /> Mix Ratios Z_ L WS Filter Pack type/ ' e <br /> installation Metho�. Surge Block: - y n ) <br /> Quantity Installed Discussed wi eologist: - ( �/ a) <br /> Type of method <br /> 29 29 <br /> EH T �f <br /> '® Chi VOW ry <br /> �}�Q6 LS Co <br />