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MONITORING-WELL INSTALLATION REPORT <br /> Date:_ CONSTRUCTION <br /> Premise Address: 40 40' Total Depth 80 r <br /> M w _3 Screen Length (from)_ BO ' _(CO) G--°_- <br /> Well No.: Filter Pack (from) 80 <br /> -(to). �'] <br /> �/ Bentbnite (from) SS <br /> _ .57 (to) <br /> Inspector. V i dia I�h ee.f Grout (from) (to).S ' (to) r ¢ e_ <br /> D O 2O '7 8Drilling rig type— Cm Permit S <br /> Permit No. Auger O.D. e I.D. <br /> �f <br /> Completion - Stove pip /crstie box circle one)Drillin Company-, �J�a'� fin ;/E_ <br /> Driller- au I S n e 1"I rove gO9•aJ'7 Gu/zrnan. <br /> --.J3�"o.t D vis cas in <br /> C_1 4 4 <br /> he_ght: <br /> Consultant Se �/VV�ronyne101 <br /> Geologist_ Jo 4 1 \ <br /> COWLS CN ck�:STY-30X <br /> SPECIAL PERMIT INFO. =7lCN <br /> Cxoucxf Suiacr <br /> Distance to serverline__N. a T prcc; <br /> Domestic well on site - (Y/ <br /> _ <br /> If yes, location and distance - <br /> Y' O <br /> SAMPLING '— <br /> zlar.� _— c <br /> � sPCicn �- <br /> Holding Temperature_ — <br /> Method__ ; - ;,, vo 1 pzYctpaoc <br /> Screening Method /�f N.� vJ:,r� P! D = _- <br /> Tracking Sheet - y n ) <br /> _80 ft. <br /> it. <br /> SPOILS <br /> Storage Method .5,5; ,ply iZdiny cq,v« MATE PdALS/DEVEI,OPMENT <br /> Contamination Noted - <br /> Storage Location o _r,4e Casing type. Sel4dIZI, 10 <br /> 40 �S� an,��-f�}�,bs�j Blank_ �o fr. Screen alb ft. <br /> GROUPING *h"e,w4j 4n V'WC — '&V F ; z4j no Slot size Q, �j ZQ j yZ,sL <br /> 4 hyafro��-,�,,, �,ln Bags cement 97-1,6 b,4 AS <br /> i , Buckets bentonite_o» SO lb Ln V' optUa <br /> Depth to waterGL - .� Bags sand/gravel_ 7 /OD -Poe Oq I mac 'f <br /> Mix Ratios- £!_ Q 4��DUy�.�j Q c e,,,w2,, 94li„t Nz I Filter Pack type/size #1- 3 <br /> istallation Method o r ,Grr Surge Block: - (y/®) <br /> Quantity Installed 3/, k s C -y 7pvov Discussed vrith geologist: - 0/ n ) <br /> or�/0^otr 1 Type of mediod N d} <br /> EH 29 29. . -low -4/Jf4 1: Fo.v+� b vtchd: Zee-- m, W- . L <br /> btz}� t� u/aS A�I'4�d¢dm.in . <br />