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JNITORING WELL INSTALLATION REPO, <br /> Date: Fe r ija r 02 I CONSTRUCTION <br /> Premise Address: - - Q r D S j , Total Depth 7�, Q <br /> Screen Length (from) `7,r (to) 7. <br /> Well No.: Filter Pack (from) 7 (to) <br /> Bentonite (from) S�G� S- (to) S� <br /> Inspector: i C�( , N�,p r Grout (from) 3 S" (to) 3 Y <br /> ,/ Drilling rig type pn P <br /> Permit No. 6S(� G 7 / � Auger O.D. ; d�a I.D. <br /> Drilling Company:_ Y� <br /> Completion - Stove pipe/ stie bo . (c' e one) <br /> ��/�6/��/�r/� <br /> Driller: cJ V a bran &p TT casing <br /> �T I 1 ( height <br /> Consultant_ <br /> Geologist �� v T <br /> ABOVE-GROUND <br /> COMPLETION CHRISTY-BOX <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line eP ��, grout <br /> Domestic well on site - (y <br /> If yes, location and distance - G <br /> TP)f a a TP If a/ 8TF C <br /> yy b <br /> �,/ N C <br /> SAMPLING CO) �l�jf/��ivl SO � ( 5C) 1�G84:� '`��� 1�'LD?y/1' slotted <br /> — <br /> G ,O �i➢Q = B <br /> �"u lead sacion <br /> Holding Temperaturexk <br /> _ T [' <br /> Method_ c�- <br /> Screening Method - I D - _ <br /> Tracking Sheet - y n ) <br /> /�tt. "� = 7� ft. <br /> SPOILS <br /> Storage Method EN - SSl-g-4Z�i1 dl-i)1-2-J MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y AD <br /> Storage Location qg.-_ CAIR _ ,)W,e-,lis�.1-. Casing type <br /> OL �, X411 Blank 47.S­ ft. Scree <br /> -.28 h. <br /> Slot size d . b 2 U <br /> GROUTING Bags cement bq s # <br /> Buckets bentonite c <br /> Depth to water 3 Bags sand/gravel - <br /> Mix Ratios r-1/W h{z o ZZ 4� c�,,9.,,� Filter Pack type/size <br /> Installation Method �r,5� - Qy „-2� �'nrb-r p�' urge Block: - ( y/ n <br /> Quantity Installed_ I 6'01-t - rn G lJ ✓ Discussed with geo ogist: - y n ) <br /> -a <br /> Type of method <br /> EH 29 29 -f-ru zk- <br /> L <br />