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MONITORING WELL INSTALLATION REPORT <br /> Date: vI0 n l 7 6 6 CONSTRUCTION <br /> Premise Address: 4a S LA r� o-&aL Tr4c° 1 , C/� Total Depth �� Fejt <br /> J Screen Lengom) �d ' <br /> th (fr (to) 3 0 ` <br /> Well No.: Filter Pack (from) -9.01 (to) <br /> Bentonite (from) 8 ' (to) 2 3 , <br /> Inspector. Grout (from) 23` (to) S a r }-46E�_ <br /> Drilling rig type `8- S 3 <br /> Permit No. 00 3G7a!Z Auger O.D. ®� I.D. 4.2 6 <br /> �l Completion - Stove pipe/duzstie box (circle one) <br /> Drilling Company: \A� K s -P Y-; l l , rt 4 a n At tl"U m`0 Cd. <br /> Driller: TI m rL/eL y r casing <br /> T height <br /> .fir, filer 's ass;.rfa t-- -R an G14ze l� <br /> Consultant (i ld Ke l u E n V f'i iY M n lc4� 1 <br /> SYS Q�'tS� �YlG. T J <br /> Geologist ABOVEGROUND <br /> Rss)Sfarv-f- W,' ndy Brown 00&VL.`TCN COMPLEMCN <br /> ca.+Pt_mcN <br /> SPECIAL PERMIT INFO. Ground Su7x� <br /> r /� 34 f eerf grout <br /> Distance to sewer line GY>a `FC✓ 7/l�rl <br /> Domestic well on site - (y/® Z 3 It. <br /> If yes, location and distance - 2 S tt. <br /> 3:0 ft. <br /> m <br /> O <br /> C <br /> O <br /> darai <br /> SAMPLING sac on = 3 <br /> Holding Temperature <br /> Method =ee in Czar ll✓ _ <br /> Screening Method D <br /> Tracking Shcet <br /> SPOILS <br /> Storage Method JrJ� 0/� m ur�mf MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/�1, Casing type P.J <br /> L <br /> Storage Location n S �L - Blank----4D-ft- Screen 30 ft• <br /> Slot size O C2:(7) <br /> GROUTING Bags cement 9 9 I b Fo r f I�-II <br /> Eucicets bentonite 2 5o Ib. Puri Lotti =3��_'L <br /> Depth to water t u <br /> d 4f 10IFeet ' Z!v-4 e,,, �30fej Bags sand/gravel 3 S" hags L4_� s ivs�rCQ r��t` <br /> Mix Ratios fO a I1 .mJ t aa�e y l G/µ lb. bud Cer¢cn� Filter Pack type/size Z <br /> Installation Method v Surge Block: - (y/� <br /> Quantity Installed 4 - 4r1! �a�Z I°6 rl l�h� a Discussed with geologist: - y/ n ) <br /> J �� d y✓ Type of method— <br /> EH 29 29 <br />