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ONITORING WELL INSTALLATION REPO* <br /> / <br /> SaWL - rQr1 L ,v sp F <br /> Date: For a2 �p'7 CONSTRUCTION <br /> Premise Address: .2,$- L-a, Total Depth '0 <br /> Screen Length (from)_ �D (to) <br /> Well No.: M W -� Q 6 V n d 1� I �1 p U l�Yl Filter Pack (from)_ .2 <br /> 1 In sB�-w, Bentonite (from) (to) <br /> Inspector. Vie- re' rYheUGrout (from) <br /> DD �� 7 8 �— Drilling rig type_ 13-,53 <br /> Permit No. Auger <br /> p Completion - Stove pipe/ •stie bok (circle one) <br /> Drilling Company: We Ls �r l� n s U Urr„rC, <br /> Driller: an ala zr- - as c,' t,4M -TJrak casing <br /> � <br /> height <br /> ¢J ��T <br /> Consultant �i s,`cs Eh •r �-q � <br /> ASSeSsm Zne', T <br /> Geologists eS JQZmi n <br /> ABOVE-GRCUND CNA1SlY80X <br /> rou <br /> OOWLEfION <br /> ON <br /> SPECIAL PERMIT INFO. Gnd Smart <br /> p Rli <br /> Distance to server lineOn kjq,aw n 9 - Zero 5"iP2 G(cut <br /> Domestic well on site - (y <br /> If yes, location and distance - ft- <br /> +Z.ft. <br /> So's I S'?" fro 4!Wle'd-e'l r/�r� '3-+,d. = e <br /> SAMPLING doted <br /> Jl secicn <br /> Holding Temperature Coo <br /> Method �v� <br /> !a}n���r iii; vl e <br /> Pack <br /> Screening Method p I D <br /> Tracking Sheet - y n) � _ <br /> 1\Iocy ft. <br /> SPOILS ['dYl <br /> Storage Method r P s,'+e- MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ <br /> Storage Location n AS e, Casing type h a-J fiJo- 40 <br /> Blank S ft. Screen /5- ft. <br /> Slot size t), 0 1 0 " <br /> GROUTING Bags cement I - g24— Y- �— <br /> Buckets bentonite Vs bay .ta fret (sola/ Moo/ <br /> Depth to water Bags sand/gravel 4-a p <br /> Mix RatiosI -114, 1w- °rt k ki III- �b64//ryt RI-4 Filter Pack type/size # Z42- L842iJ l u hre(�OOa <br /> Installation Method r Surge Block: - (y A�q) I V — <br /> Quantity Installed I b 1 h Discussed with geologist: - f& n) <br /> Type of method tJ ®. <br /> EH 29 29 <br />