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ONITORING WELL INSTALLATION REPO* <br /> Date:_ 6 _ CONSTRUCTION <br /> i _ p r7� <br /> Premise Address: q-Z S- L4 rclL Rot ' Total Depth oZ U <br /> FIs Wpm( Gr,rgj Screen Length (from) a-0 ` (to)--�— <br /> Well No.: M W - 2 3 - a rnts��! td�44-ov Filter Pack (from) -7 t (to <br /> d17 8523/ w Bentonire (from) `f ` (to) <br /> Inspector. �I G� t m g� ✓ L24 �r4e f�� Grout (from) 3 ' (to) Surg c� <br /> Drilling rig type - S-3 <br /> Permit No. S 0 0 4' 8 .2 (a L Auger O.D. " I.D. <br /> Completion - Stove pip clistie Rotes (circle one) <br /> Drilling Company: WW e4cy -d) <br /> Driller: `k CA 4, - casing <br /> nl4rCwS Ur� GdJ- 2JJr'rJl�.r�- height <br /> ;& tru <br /> Consultant I_ D�� fir/r/ �ryieyc� ` <br /> �IIGJJ <br /> Geologist �YJh2 EJ JL{ z/?2 i i A80V&GRCUND <br /> COkFLETION CtWISTY 30X <br /> SPECIAL PERMIT INFO. ��Ground$udan <br /> Distance to sewer line f./� ,e Y OBJ ngrout <br /> Domestic well on site - (y/ n ) ♦ /�A NJ23 3 ft. <br /> If yes, location and distance - tI r S _ g, <br /> tt. <br /> IN)z1- ?: _ .: <br /> SAMPLING • do led <br /> 6 mw3A.Ivotik I'cn <br /> Holding Temperature Coo lam✓ LUr r c C = gavel Pact <br /> Method P oo ui '+�2 <br /> Screening Method -PI-D = <br /> Tracking Sheet (y/ n) )/I?ff <br /> ft. tte <br /> SPOILS o <br /> Storage Method J &f/-),JMATERIALS/DEVELOPMENT <br /> Contarnim <br /> Storage Location On S Casing type ft <br /> Blank i ft. Screen <br /> Slot size <br /> GROUTING Bags cement9o <br /> /.2fi13kks-Buckeu bentonite To re. Colo �.0 m <br /> Depth to water / - � .;Sf �6ZEBags sand/gravel 5 - 1"hL 9=!rr� <br /> Mix Ratios z 0 # T Y Porg14,,,'Filter Pack type/size .2 <br /> Installation Method✓ u r 3 Surge Block: - ( y/0 <br /> Quantity Installed - 7yruV g-Discussed with geologist: -(y'y n ) <br /> Type of method <br /> EH 29 29 <br />