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MONITORING WELL INSTALLATION REP`ORT <br /> I ' <br /> o CONSrRucnON k <br /> Date: <br /> 11� r' . e Total Depth <br /> V J <br /> Premise Address: 02 Screen Length (frorn) G 5 , (to)_ 57 ' <br /> e Filter Pack (from)from) (to) S` 5' <br /> Well No.: mW Bentonite C <br /> ' Grout (from) 5`<•S' (to) s v <br /> Y ' r Drilling rig type G S <br /> r. ,r I.D. . Z, <br /> Inspector- S <br /> 1 Auger O.D. <br /> permit No. Completion - Stove pipe/christie bas (circle one) <br /> or , <br /> Drilling Cor--spa.ny: <br /> _ casino <br /> Driller: Sn he_5ht <br /> �3ss•'�sfa� s" JD6�� <br /> ire, On Je{ f(ar)iema �r <br /> A EnJiro�rne <br /> Consultant _ - <br /> Geologist + S ApovF_.GRCI•IND CHRZTY.$OX <br /> d f eor 4e w¢j di- 'rar,1 /U f'e�` 4S Fc�}c�l�t..�,r�oti G=rd s� lata mc{� <br /> SPECIAL pEPLMIT INFO- grout <br /> Distance to sewer line <br /> Domestic well on site - (Y/Gay <br /> If yes, location and distance - <br /> a <br /> o� ,-d r f .4curn�le� . a <br /> FIodor <br /> FI Dr d, s tr�crc �zu nor? , SL ' ,r�4S' slor� y <br /> SAMPLII wrc ea lac 34 , 43 <br /> Holding Temperature <br /> Method <br /> Screenin;Method — <br /> Tracking Sheet - Cy)/ n ) - n- <br /> 1.I �4•�j' � G�� <br /> rP�ru-��'JfZ� ,�: � so. I W4J Cld - <br /> SPOILS �x-r R Gtr cdz�ld'mat 9 4 41141116.- S4li�owAe <br /> `4}q rP MATERlALS/DEVELA_ pMENT <br /> Storage Method sf r <br /> Contamination Noted - (Y Agn Casing type SC Screen s <br /> f 4 ? <br /> Storage Location +� .�,�G� Blank U ko 9',s ,) <br /> Slot size _ )b. bQ S <br /> �r i l�a-Y j Bags cement 3� „ <br /> GRlOIT1ING wa;.-!f y,- uckets bentonite <br /> sa.Y,.'Vaks sand/gravel . 5 Wv <br /> Depth to water �, r,/� //p pack type/size I t Lu G # <br /> Mix Ratiosr0 n Surge Block: - n <br /> Installation Method Discussed with geologisZI <br /> t' - n <br /> Quantity Installed <br /> }�` 'Type of method S' <br /> EH 29 29 '� a ve.rs;de, Por} Q►�� .TNS ee 1 vY )1?fl�`Gri a( <br /> 1 / J R,»�G Paf. <br /> - .S�"L�'�.T�C SLj rip/:�! s t!./r�i�Q R�•�'7 � sa n�. <br /> _ v <br />