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MONITORING WELL INSTALLATION REPO <br /> Date: 42- k/o CONSTRUCTION <br /> Premise Address: lova Al' 4w C/ Total Depth X35 <br /> Screen Length (from) —(to)� <br /> Well No.:D `f Filter Pack (from) i:j j (to) ,Z 2_ <br /> 1 /� Bentonite (from) 11 z (to) a <br /> Inspector: r'7�" �C Grout (from),)2�d�(to)- <br /> Drilling rig etyq y /� sl <br /> Permit No. -'7Q 6�9l Auger O.D. Q / I.D. 8 <br /> Drilling Company: (�I <br /> //�� S c.c�-�k.. Completion - Stove pipe/christie box (circle one) <br /> • \ <br /> Driller: ` <br /> casing f <br /> � " / <br /> Consultant �C{-r� °��,c(( ( T height <br /> i 1 <br /> Geologist (, �✓ <br /> COAFLETION P ON <br /> SPECIAL PERMIT INFO. prmnd Sulam <br /> Distance to sewer line gran <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - <br /> m <br /> -- a <br /> m <br /> SAMPLING = <br /> slotted = B <br /> yp� sacton _ - <br /> Holding Temperature <br /> Method !3A 4-1, / t?v✓ _ 7'VW Pack <br /> Screening Method —_ <br /> Tracking Sheet - 6YI n ) _ <br /> SPOILS Q/J � <br /> Storage Methods t%i w Szf P MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( /(r�) �" p �y W- /J <br /> Storage Location �-. P " <br /> , t/a.-R C d[ Casing type oZ "Pt/L- <br /> V f Blank I U fr. Screen !D ft. <br /> Slot size_ O.-02b <br /> GROUTING Bags cement pp147 <br /> Buckets bentonite I/VoO <br /> Depth to water Ngo 1�(y5 Bags sand/gravel_ q froze <br /> Mix Ratios Filter Pack type/size L/I L <br /> Installation Method Surge Block: - (y/6) <br /> Quantity Installed Stn 'f7� Discussed with geologist: - / n ) <br /> EH 29 29 Type of method <br />