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N,.uNITORING WELL INSTALLATION REPOIN� <br /> ,DaA� -- �4rf� do✓l� <br /> Date: 7 -// - o ,7 ,p CONSTRUCTION <br /> Premise Address: 29L9 LaQ.rnls Total Depth '�.S- - <br /> Screen Length (from) -1144 , (to) fff 2- <br /> Well <br /> Well No.:_ C LtJ - 2 Filter Pack (from) (to) 41 ' <br /> Bentonite (from) 4-! (to) 3.3 <br /> Inspector: _ Grout (from) 33 (to) /57 -,-id' z' <br /> Drilling rig type <br /> Permit No.- r7 se a c7 le 2 Auger O.D. 9 1k. I.D. Z <br /> Completion - Stove pip Christie (circle one) <br /> Drilling Company: V It- IV ��''� )� ��� <br /> Driller: Fra <br /> t ; r e Z casing <br /> Assi.Sf S % �lt1V i AGa-y 'd Juan 544neo � height <br /> n <br /> Consultant enc <br /> � <br /> Geologis a el A no <br /> ABOVE-GRCUND <br /> COM?LEMN COMPLETICN <br /> SPECIAL PERMIT INFO. Ground Surfws <br /> Q 10"0Z' <br /> Distance to sewer line ? / tfi"D aPe_� -�'OL SD Of0"t r11 <br /> Domestic well on site - (y/0 3.3 .ft. 1,6, <br /> If yes, location and distance - NA <br /> �ft. /S'' <br /> IJo P D re-4d;-xV W4.i <br /> 4rrv" -ts 13 41 -- <br /> SAMPLING _ n pn e- 4-* ,sem// elor.#.i <br /> 'f d ):F s4� aoc7cn <br /> Holding Temperature /� Q.n.��►revqel " = paver Pack <br /> Method N d <br /> Screening Method 14 A _ <br /> Tracking Sheet - (y/ n bl A — <br /> S ' 4 ft. V <br /> SPOILS - -,10 2- <br /> Storage Method SY ' Ot 44 InJ MATERIALS/DEVELOPMENT <br /> Contamination Noted - ) , <br /> Storage Location _.!'i�'� Casing type 'P. I, " " <br /> Blank 2 ft. Screen 2- <br /> Slot <br /> Slot size 6. 0 2 0 i <br /> GROUTING Bags cement " E41 L <br /> -Buckets bentonite 1 Ftiioz. <br /> Depth to water r Bags sand/gr avcl .2 <br /> Mix Ratios Ti,t -�� Filter Pack type/size 3 - <br /> Installation Method }J a/pSurge Block: <br /> Quantity Installed eke he ie . T-jt-b7 Discussed with geologist: - n ) <br /> �Type of method At 1� <br /> EH 29 29 S�Qe Li W41 <br /> 1.J'�'C <br /> 7*�i�j ra v�' Gtr i l l - �2,OIC �'�"/rs <br />