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Iv.„jNITORING WELL INSTALLATION REPOh, Il <br /> Date: 'r d -D CONSTRUCTION <br /> Premise Address: 2q 9 /-00M 1"5 Total Depth <br /> Screen Length (from)_ (to) <br /> Well No.: �W - ( Filter Pack (from) (to)—17- <br /> f . Bentonite (from) 2 _(to) 4 <br /> Inspector: �1`&k M 0- ,r,+n a,C4 Grout (from) -1/0 (to) 2 , <br /> 1 Drilling rig type (3 K -8 1 0r l4e- <br /> Permit No. 60 5 O 14, Auger O.D. R ; a AJ-L I.D. 1,, ;ZS i ne4S <br /> Completion - Stove pipe/ u-istie b (circle one) <br /> Drilling Company: t- UV �r; �; <br /> Driller: Fywnk- Am'i rez I t <br /> T casing <br /> / �rtl noe JU4/J rr., T height <br /> Consultant eo 7 T-n c. <br /> z OQ � Y7�'CS Y <br /> Geologist Jo /4n q ..16 -- <br /> /180VE-GACUNO iS I1f <br /> COMPLETlCN COMPLETICN <br /> SPECIAL PERMIT INFO. Suriacs <br /> grout <br /> Distance to sewer line 5 10 O__ <br /> Domestic well on site - (y/(0 ft. <br /> If yes, location and distance .� Z ft- <br /> �ft. <br /> go <br /> SAMPLING - r1 a 71 e, L1,�e` �Q`�¢'" slorod = C <br /> -I O soden — <br /> Oi►' <br /> Holding TemperatureVol Pack <br /> Method Ale 34 -deet <br /> n ::.Yr^• <br /> Screening Method — <br /> Tracking Sheet - (y/ n) NSI r4 e­ - <br /> �l �ft. .� � it- <br /> SPOILS <br /> Storage Method 6 drotns MATERIALS/DEVELOPMENT <br /> Contamination Noted - / n) <br /> Storage Location e 4 S i fG Casing type <br /> Blank 43 ft. Screen 2— <br /> Slot <br /> Slot size 0. U ad i n <br /> GROUTING Bags cement N 7 ,IT <br /> Buckets bentonite of <br /> Depth to water r - 2 ems- Bags sand/gravel_7 >? <br /> Mix Ratios &0 AijjA4-j- olLwAPAg- +v.1L'­q4JbJv4,e,4 Filter Pack type/size <br /> Installation Metho Ce-m Surge Block: - ( y/ n ) <br /> Quantity Installed N -j'� j7-Zj- Discussed with geologist: - 0 n) <br /> Type of method kr* <br /> EH 29 29 <br />