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i <br /> lNITORING WELL INSTALLATION REPO; .i <br /> Date: �� ' Z ' CONSTRUCTION nl4r- <br /> Premise Address: L j5jff7 ( f Total Depth <br /> + Screen Length (from) (to) <br /> Wel! No.: lt) `s (�a 13 Filter Pack (from) a (to) — <br /> � 4{ Bentonite • . (from) 5 (to) <br /> Inspector: Grout (from) 5.5 (to)' <br /> Drilling rig type ax. c <br /> Permit No. cY2 �� Auger O.D. .2 Y.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company:_. {.v��t•�65- <br /> Driller: 12LG T casingT <br /> IFheight <br /> ,,Consultant <br /> P .!A- 11 <br /> Geologist � '��10 <br /> ABOVE-GROUND CHRL.SIY-80X <br /> COIFLE ION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line ?'S ofout <br /> Domestic well on site - (y/®) . - ft- <br /> If yes, location and distance - ft. <br /> a <br /> SAMPLING slot" <br /> aocicn — <br /> Holding Temperature 'C- F <br /> Method — <br /> Screening Method <br /> Tracking Sheet (( Y n ) <br /> eft. <br /> SPOILS <br /> Storage Method d 1f AAS-n C- MATER.iAI.S/DEVEI,OPMENT <br /> Contamination Noted - {y <br /> Storage Location OW 5,71:5- Casing type !!E1 Stl ! Qx1 L 1L - <br /> BIankft. Screen, 2 ft. <br /> Slot size <br /> GROUTING Bags cement <br /> _ Buckets bentonite <br /> Depth to water ar Bags sand/gravel <br /> Mix Ratios 3 to Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n } <br /> Quantity Installed Discussed with geologist: - (y/ n )� N�� <br /> Type of method <br /> EH 29 29 <br />