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NITORING WELL INSTALLATION REP01% <br /> Date: CONSTRUCTION <br /> Premise Address: _ ? L0024jTota! Depth l3 feed <br /> Screen Length (from) i 3S (to) /25 <br /> Well No.: Filter Pack (from) l�S .. (to) <br /> Bentonite (from) _/Z 3! _-(to)--/ZO 11 <br /> Inspector. V i �.�C iI�, Grout (from) 12 O ` (to) r i;L- <br /> Drilling rig type r, 5- <br /> Permit No. JYD `(a Auger O.D. L ` Op <br /> Completion - Stove pipe/ urisrle box (circle one) <br /> Drilling Company: � � .rhe, <br /> Driller: YYl s f -S'fe�oh casing <br /> L rr�SRnf' ► �`ro he,'ght <br /> Consultant &gqk. 1 <br /> Geologist <br /> ABOVE-GRCUND <br /> Cb M➢�LETlO�d Ci�itSTY-80X <br /> COMPL.E nCv <br /> SPECIAL PERMIT INFO. Gourd Surface <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - { y/0 �r_._f � <br /> If yes, location and distance - 23 Pt. <br /> N <br /> mC <br /> SAMPLING A(6 S4.na flej if?o4e_ Pi o �lorni <br /> s�rticn �" % <br /> Holding Temperature Af 14- <br /> Method q: — 9MYW Pack <br /> ,4v <br /> Screening Method Afff <br /> Tracking Sheet - ((Dn <br /> 135- tt. ' _ ! tt. <br /> SPOILS 4Srriynu <br /> Storage Method - "J MATERIALSLTEVELOPMENT <br /> Contamination Noted . {y n f <br /> Storage Locationn.s) v Casing type - __S�!I/� -, 40 <br /> Blank f 2 S ft. Screen / 0 ft. <br /> Slot size <br /> GROUTING Bags cement h 't 7-j b <br /> -Buckets bentonite `� 31R <br /> Depth to water 'Rmc- Bags sand/gravel <br /> Mix Ratios 7 b N'3 9 I{z d fpaleFilter Pack type/size3 <br /> Installation Method rr `en- Surge Block: - V/ n ) <br /> Quantitylnstalled-_ SS' , �.frfl Discussed with geologist: - 0/ n ) <br /> ]� j;�:-e-� Type of method 51 r <br /> EH 29 29 ( `7-1 �'4 <br />