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MONITORING WELL INSTALLATION REPS "T <br /> Date: N n 1/C Y)1 h 2r' Ig 2.a D S CONSTRUCTION <br /> Premise Address:_ L7+9 E&5t md i n s�. Total Depthgo -Agel /S A <br /> Stoc.K�syL Screen Length (from) BD (to)_ L ._S <br /> Well No.: M N/ - N 1 1 Filter Pack (from) 55, (to) _,q-1 ' <br /> Yin <br /> Bentonite (from) 53 ` (to) _xli ' <br /> Inspector: i e•k l C',�•Y n Grout (from) S-U ` (to) Sy rnpey W-- <br /> Drilling rig type_ <br /> Permit No. '44' B to f'i Auger O.D. J Q In AJ, I.D. 6. 2.4-'` <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: �!', 14� Ta b.&_ <br /> Driller: 7_6 n u J/3 Yd rn i 1 6 casing <br /> COT :1� 1 M .- -Imo' .D4(/�r height <br /> Consultant 0 YL e� M W h <br /> Geologist T <br /> L 1 CDX' ABOVE-GROUND CNRZ Y-80X <br /> I COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. pend Surface <br /> Distance to sewer line YL h+ k rz o%2z:j grout <br /> Domestic well on site - ( y/ n) 5-0 n <br /> If yes, location and distance - 3 ft. <br /> T'lyO rnaYnI CW J ft. <br /> 44�0S)f /t7D 0 4- J}" <br /> N' C <br /> SAMPLING <br /> ' stoned <br /> a rMP/tfXv ''L scion <br /> Holding Temperature <br /> grx��Pte* <br /> Method A/A 54 0 at4, <br /> Screening Method N !}- �``� '} <br /> Tracking Sheet - (y/ n ) <br /> SPOILS r <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/(Zli <br /> Storage Location Casing type _F0 <br /> Blank 5 ft. Screen 2 r ft. <br /> Slot size 6. " <br /> GROUTING Bags cement 14 # <br /> Buckets bentonite 3 „r <br /> Depth to water (�,S Bags sand/gravel <br /> Mix Ratios /7 20 .J Filter Pack type/size / Z /L <br /> Installation Method Surge Block: - &n ) <br /> Quantity Installed 31 4-7-d- Discussed with geologist: - n ) <br /> ���•���,�( �.,Z-, <br /> EH 29 29 Type of method <br /> -t'►�t e✓9 ea+,ee4 bo rb!-,ejtn 1 ,e G4.4 jbj <br /> 114.,! At -1 Z 3 <br /> �} s' L 8- T t'. 6iro k.�G�v <br />