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S...'NITORING WELL INSTALLATION REPOI,../ <br /> Date: 7- /ay -7 CONSTRUCTION <br /> Premise Address; ,2 9/.- 4 Lap,,9 ,/ G�dt� Total Depth <br /> Screen Length (from) _ (to) S/Z <br /> Well No.: lif/ Filter Pack (from) -'/Z (to)_� ' <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) -7 (to) Z et rn� <br /> �yDrilling rig type <br /> Permit No. V 0 S-0 �4 Z Auger O.D. I.D. <br /> Completion - Stove pipe/clu•istie box (circle one) <br /> Drilling Company:_ y `a- 1 1- <br /> Driller: r Z cas Ing <br /> SjS }a'yt J": D4\/io( G Jud, rrG-»c� helq'ht <br /> Consultant 6'"I#-z, <br /> Geologist J0 e— - <br /> AiOVE-GACUND <br /> CO fP LET{O N CNAISTY-SOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Sudacs <br /> Distance to sever line YJ 44 47 �/u <br /> Domestic well on site - (y/n <br /> If yes, location and distance - N a R, <br /> 'I <br /> —42--ft. <br /> SAMPLING — yy,.Q_, = s <br /> slot:ad <br /> secicn _ <br /> Holding Temperature AIA <br /> ack <br /> Method F <br /> Screening Method . —_ <br /> Tracking Sheet - (y/ n) :;x — <br /> 44 a. _ <br /> n. .� 4 f2. <br /> SPOILS / <br /> Storage Method ��� r MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( /n Y <br /> P✓L <br /> Storage Location ba S)' �e— Casing type o2 <br /> Blank ft. Screen 2— ft. <br /> Slot size 0. 0 Z 0 <br /> GROUTING Bags cement 12 bAd - o� <br /> Buckets bentonite 2 SD �-� <br /> Depth to water Y Bags sand/gravel I, S ia1411• /OD-)h <br /> Mix Ratios !i,, Filter Pack type/size 4-30 <br /> Installation Method r � S' Surge Block: - (y n <br /> Quantity Installed Discussed with geologist: - (©/ n) <br /> Type of method A� f9- <br /> EH 29 29 <br />