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*ONITORING WELL INSTALLATION REPO <br /> IY <br /> Date:_ CONSTRUCTION <br /> Premise Address:_ 4L45- 1-4r-dA 2p( Total Depth_ <br /> Wel] No.: P - / TnrV PC . /) Screen Length (from) 20 <br /> Filter Pack (from) ZO ` (to) 3-t <br /> Inspector: Yi r /n <br /> Bentonite (from) 3.�_(to) Z,y <br /> �A f fyy ate, Grout (from) V,�i_ (to) 46 <br /> �— Drilling rig type J_;ojj4.ge hmfar 2 ` <br /> Permit No. D S0 3 Auger O.D. J., jk I.D. <br /> Drilling Company: T, i Completion - Stove pipe/christie box (circle one) <br /> � I l �" " <br /> Driller: GLf r"v n n rLlY'/"iq A p �1c !✓1GL[ 9�l casing <br /> �.Y-n 6lrrnl d- A-S9o, �Y-� r1 �'�1 height <br /> ConsultantJ <br /> Geologist Gin " utnA --Or <br /> ABOVE-GROUND <br /> COMPLETION qtX0 <br /> SPECIAL PERMIT INFO. COMPLETION <br /> Ground Surface <br /> I s <br /> Distance to sewer line_ 7-Feet grout 0 <br /> Domestic well on site - (y/(D) I <br /> If yes, location and distance - ♦ ft. <br /> 8,3' ft. <br /> ft. <br /> a <br /> _= m <br /> O <br /> 0 <br /> SAMPLING — o <br /> abtted <br /> aacton _ <br /> Holding Temperature__ ¢oe/ <br /> Method 9hY64Pa <br /> Screening Meod LD rG PIU fL4� i <br /> th _ <br /> Tracking Sheet - (y n ) <br /> SlieO.�. 20 ft. = 2D ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ((j n ) <br /> Storage Location__01,1, fL Casing type /r ri4/4 c�Bl2 a1¢yQ <br /> Blank .S ft. Screen /S ft. <br /> 4),/6>L; V_F""` slot size 17 , 0 Z i„&I aj <br /> GROUTING UU Bags cement / 47-10 Jag f z)A5 sWa <br /> 1ueketsbentonitej}a/ailua 3 '/A 6fa5616 116 <br /> Depth to water s i s Bags sand/gravel_ /0 L'a <br /> MixRatios 147 I b 64� Lia / La 1G COFilter Pack type/size 3 <br /> Installation Method r /ek b pCk4,1:-- Surge Block: - (y �v <br /> Quantity Installed // bad Discussed with geologist: - CY�r n ) <br /> Type of method 4V/11- <br /> EH 29 29 he ry u+ 1'jds )"2 4 `5'84'lnk <br />