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i <br /> I <br /> M �.._JNITORING WELL IN <br /> REPO:. ) <br /> I <br /> i <br /> Date: ID • q 'C?,?-- CONSTRUCTION <br /> Total <br /> Depth ¢f 33 <br /> Premise Address: P <br /> Screen Length (from) + (to) <br /> Well No,: Vw 4- �." 12 Filter Pack (from) 33 (to) u <br /> } ' . Bentonite •- (from) ' ' (to) !3' <br /> f � <br /> Inspector. '�• �C+��, � � y Grout (from) Aor (to) N <br /> ,. Drilling rig type 6, CM LT <br /> Permit No._q 1. 3 Auger O.D. I.D. �r <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: 97 <br /> Driller: i2LcAaus casing <br /> he;ght <br /> Consultant <br /> Geologist CLQ-u,�o <br /> 1 M&E-GROUND f `C�15TY-80X <br /> CaMPLET�ON w COMPLETION <br /> SPECIAL-PERMIT INFO: Ground StsiaGs <br /> Distance to sewer line Grout <br /> Domestic well on site - (y[ ft. <br /> If yes, location and distance - <br /> SAMPLING" ', . . :lora.9 k <br /> sat1cn <br /> Holding'Temperature g„i pack <br /> Method /Cts &X6 C557 — <br /> Screetiing Method <br /> T. <br /> Tracking Shcety n ) :a. = a <br /> �.._�tt. ....-.._.. ft. ' <br /> SPOILS <br /> Storage'Method big! Aq-&Mc—' ti s` MATERIALS/DEVELOPMENT f <br /> Contamination Noted - (2� n ) 44nom C 31u <br /> Storage Location OAI 5r7E } `Casing type SL <br /> Blank ft. Screen L ft. <br /> • ' ` `_ T% Slot size' 6 ­10. 1 a ' <br /> GROUTING .. Bags cement <br /> ' Buckets:bentonite <br /> Depth to water l�l�' Bags sand/gravel <br /> Mix Ratios ?_ �,,tl' '30 Filter Pack type/size_ <br /> Installation Method s- Surge Block: - (y/ n ) ` <br /> Quantity Installed - Discussed with geologist: - ( y/ n ) <br /> Type of method / <br /> EH 29 29 <br />