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SwJNITORING WELL INSTALLATION REPOT,.,. <br /> Date: 7-/10 0 CONSTRUCTION <br /> Premise Address:_ '2 9 0 q L o p'W;.r Total Depth_ J�� -Fe <br /> Screen Length (from)Well No,:—, E W-103 Filter Pack (from) <br /> ��� Bentonite (from) 5`14e,.t (to) 5 fe <br /> Inspector- —JLL1-k.' r71� e- �r f-h L-4r Grout (from) <br /> Drilling rig type B <br /> Permit No. 00 5-0'9/o Z Auger O.D. n I.D. <br /> Completion - Stove pipe u-istie bo (circle one) <br /> Drilling Company:_ U W r, �) ; <br /> Driller:_ rr(',2k <br /> . . <br /> '4 <br /> casing <br /> G�� 4 � 7- height <br /> Consultant Gcs �n� <br /> Geologist jo 1o <br /> -- <br /> /180VE-GACUND CNAI3TY-SOX/ <br /> OOMPLETfON " 0 <br /> SPECIAL PERMIT INFO. ,n G=nd Urfact <br /> Distance to sewer line /0 O -�eJ flrout <br /> Domestic well on site - ( y/0 <br /> If yes, location and distance - ft, <br /> rA. 0 <br /> N a P 1 � r end 0s <br /> s: o <br /> SAMPLING e3 O 71 e- glot'od = � <br /> r soden <br /> Holding Temperature 1�1}'� Gl - Sur a 31 - <br /> `� / �w• gavel Fade <br /> Method ,}yl sly vve 31 l <br /> Screening Method �nra✓e.( I'- 1/I. <br /> Tracking Sheet - (v/ n ) N 4/.S�_ ' cf ay s,l i- <br /> SPOILS <br /> Storage Method ��" - /}J j On-Pl MATERIALS/DEVELOPMENT <br /> Contamination Noted • - n ) <br /> Storage Location ro Ji f f Casing type i e2 ZA FV c' <br /> Blank ft. Screen <br /> Slot size 4. O.Z i <br /> GROUTING Bags cement ✓'' `P _ <br /> 3/$A ;B�cl:ets bentonite I - F -ff <br /> Depth to water r - /I �P�r Fags sand/gravel 4�- <br /> Mix Ratios--J-L- q j - 6 Q ��� Filter Pack type/size <br /> Installation Method 9 �- -fw �Surge Block: - ( y/ n <br /> Quantity Installed "L-' f Discussed with geologist: - (0 n ) <br /> Type of method P4A <br /> EH 29 29 <br />