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.JNITORING WELL INSTALLATION REPO.,., <br /> 'Da!/j - S d 4 WL �;/� 2 30"s <br /> Date: � � y n.Z 7L 5'Q 13 _ CONSTRUCTIONII V <br /> Premise Address:_ o2.2Z L) � y�,`}��,t�,p�� Total Depth <br /> Screen Length (from) (to) <br /> Well No.: y W, Screen <br /> Pack (from)_ a6,4 (to) _ <br /> Inspector: Bentonite (from) (to) Z , <br /> .},9,� --6rout (from) ([o) Sct e A- e <br /> Permit No. 0 b 3 �jrill' g rig type_ [M E 7S- <br /> - ii�u r O.D. JO iAOL I.D. <br /> CdK Completion - Stove pipe ristie o (circle one) <br /> Drilling Company: All vie i( A b <br /> Driller:_ J Ua (..C, - /, casing <br /> �a1 Ie_a' <br /> / height <br /> Consultant ACE <br /> � nrf� <br /> 0Geologist ABOVE-GRCUND <br /> COk9LETCN <br /> SPECIAL PERMIT INFO. Ground Sufacs <br /> Distance to sewer line $a -FGI - grout�� 1� �[_440641 <br /> Domestic well on site - ( y/ �j <br /> If yes, location and distance ft.Clnt,f!� � <br /> Win. = ft.� <br /> — m <br /> b <br /> = m <br /> SAMPLING — o <br /> t to rted c <br /> aoccon — � <br /> Holding Temperature_ S� — <br /> Method_ '� . iv, _ Gavel Pack <br /> Screening Method _— <br /> Tracking Sheet - y n ) — <br /> n. <br /> SPOILS <br /> Storage Method 5 - MATERIALS/DEVELOPMENT <br /> Contamination Noted - n a <br /> Storage Location 45 „-t ` ,L Casing type q x 44 s� x 5Ld <br /> Blank $- ft. Screen fr. <br /> Slot size <br /> GROUTING Bags cement saI e WN 14&41-T- <br /> N ' <br /> r 1 / IP4 •B bentonite - i(a' �e.�. <br /> Depth to water ! TCL7 dBags sand/gravel 6 .��/j4 / <br /> Mix Ratios <br /> / {�,Filter Pack type/size 6 U.,., c <br /> Installation Method W. rnd�” boSS Stege Block: - ( y / n <br /> Quantity Installed ,e Discussed with geologist: - �/ n ) <br /> EH 29 29 L4-10S�-Z0 ` ! Type of method <br /> --h +k4- syJ-t-'O-m. h y-4,4� 4-4, ie.,A;fi. <br />