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• <br /> MONITORING WELL INSTALLATION REPORT <br /> CONS'l <br /> Date: l � 1AilS� 2. 2ODS p <br /> �I Total Depth D Fpv r <br /> rn $' I <br /> Premise Address: X5, 1 n Screen Length (from) A�(to) <br /> 20' (to) 'I,S <br /> M '9 Pack (from) _ <br /> Well No.: Bentonite (from) 416-1 - <br /> (to) 3,5-1 <br /> Grout (from) 3. S ' (to) ouy-44cs <br /> Inspector•. \I I G L/", M � ��� �n eN Drilling rig type3 <br /> Auger O.D. `n LD. :2 in <br /> Permit No. t) :j 3 2 7 — Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: -. + �• i n 4 <br /> f casing <br /> Driller: I e n <br /> � height <br /> Ass{sliiNa' - 1 ar, Glaze p <br /> —i <br /> Consultant y <br /> Geologist <br /> ^ ^�9 P S �a Z YI7 i n Ai0VE-GRCUN0 Z Y30X <br /> - rorcJh tx)NVL=-TCN SS i 5 f G}n Cxwrd suiac*50 5'6 <br /> —�---- <br /> SPECIAL PERMIT INFO. T <br /> /0 ' 2.91 PBS or«n <br /> err nOtJr� <br /> Distance to sewer line �p D,> Pip ft. <br /> Domestic well on site - (y X27S tt. <br /> If yes, location and distance - ��ft. <br /> _ <br /> l <br /> a"W <br /> �c prnGxrf. �lorad = S <br /> SAMPLING!/ �acicn <br /> Holding Temperature <br /> Method <br /> Screening Method = . <br /> Tracking Sheet - Un ) - <br /> 11. <br /> n �� S7 <br /> "S L� �� " <br /> �e,lf e , c <br /> SPOILS <br /> Storage <br /> MATERIAL <br /> Contamination <br /> S/DE 'OPMENT <br /> nation Noted - �^) •� Casing type —Sil <br /> ! �v�z 4 ft <br /> Storage Location Blank 5-- Screen )�_— <br /> Slot size <br /> Bagscement <g77 C <br /> GROLITING Buckets bentonite �•', <br /> tu�k�ulBabz sand/gravel <br /> Depth to water Gr S �.. 19/ <br /> Filter Pack type/size <br /> K e F Ib bQtru s✓ Surge Block: - (Y n <br /> cooisr (y <br /> . - <br /> Mix Rados > 3/ t <br /> Installation Method •Ae Type of method <br /> Discussed with g g <br /> Quantity Installed J / Ali e d <br /> �yf--ter-�1" , I+ <br /> EH 29 29 pVmr Yey .Y►L4✓ /9 . <br />