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OONITORING WELL INSTALLATION REPO <br /> Vaor i�xtkA144� W&5 CV GVJ) <br /> Date: 3Z31/Ism S �IZ � CONSTRUCTION <br /> Premise Address: Ll �./.�j b p l��1 t ��� Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Z Drilling rig type L� <br /> 3 <br /> Permit No. 05 j5—? Auger O.D. S; I.D. q, 2-t <br /> Drilling Company: Vf DC Completion - Stove pipe/christie box (circle one) <br /> V r� <br /> Driller: II � At-`�/ �1/ V d(r casing <br /> Consultant �G'V S iCO/vj height <br /> Geologist <br /> ABOVE-GROUND <br /> COMPLETION CHRSTY4= <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground SLw}xy <br /> Distance to sewer line vYZ (LKd(�N� k�l Groot <br /> Domestic well on site - e n tt <br /> If yes, location and dis e - ft <br /> = m <br /> — e <br /> SAMPLING $lotted i = <br /> $ec5on �- <br /> Holding Temperature / LI <br /> lyethod graval Pa <br /> - — <br /> Scree ethod — <br /> Y:: _ .. <br /> Tracking Sheet - / r " — <br /> r <br /> SPOILS <br /> Storage Merhod rj d7v1 MATERIALS/DEVELOPMENT <br /> Contamination Noted // <br /> Storage Location k _ .I Casing type <br /> /ZC0W✓ �' 4ct(Vt �� '2 vV�Y/�S Blank ft. Screen ft. <br /> f-fe•?� i47ri<c1 CpYk�w� Slot size <br /> GROUTING 1-st S;-tv . Bags cement <br /> /J Buckets bentonite <br /> Depth to water rYf l0 v6i Bags sand/gravel <br /> Mix Ratios Filter Pack type/siz <br /> Installation Method 471 11 Surge Block: - (y Aaj <br /> Quantity Installed Discussed with geologist: - (y/ <br /> Type of method <br /> EH 29 29 <br />