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t <br /> eINSTALLATION <br /> MONITORINGiREPORT <br /> Date: CONSTRUCTION <br /> Premise Address:,a�O is hia r 1$�ncAt kv SCA Total Depths <br /> Screen Length (from) '3 o (to) -35 <br /> Well No.: Filter Pack (from) ?;I (to) 35 <br /> _ Bentonite (from) 2s (to) 24 <br /> Inspector: TQd 1 is i eRp,� o . _ Grout (from) I (to) 75 <br /> Drilling rig type GMC 'Ir <br /> Permit No. O O C,5 20 I Auger O.D. 0 I.D. 4 Y4 <br /> Completion - rove pipe Chri <br /> Drilling Company: C35C� D �{�im 4,{-�.�k stie box (circle one) <br /> Driller: T♦. Sa-( d4 "- casing <br /> � p 31Y G�v�roY.iv"„r� Sec.L�wb 'su �Y�`1')��c • W <br /> 9height <br /> Consultant " <br /> —EWT <br /> GeologistI)oa <br /> ABOVE-GROUND <br /> COMPLETION c4-SIM-Box <br /> COMPLE71ON <br /> SPECIAL PERMIT INFO. Ground SUtlaca <br /> Distance to sewer line -1. _ grout <br /> Domestic well on site - (yAGC� ZS <br /> If yes, location and distance - * n' <br /> � 2 ft. <br /> ft. _ <br /> V _ e <br /> SAMPLING t,4nc clotted = <br /> coc6on _,P _ <br /> Holding Temperature <br /> Method = grafi Pack <br /> Screening Method <br /> Tracking Sheet - (y/n35) <br /> tt. h. <br /> SPOILS M <br /> Storage Method agjs L@ vo l-a-md 6r MATERIALS/DEVELOPMENT <br /> Contamination Noted -9/n) <br /> Storage Location vu, Siiiu aQ 3C{t Casingtype Z" sclntAl 1�1[- <br /> Blank io ft. Screen 5 ft. <br /> Slot size n.010-i L. <br /> GROUTING Bags cement ! 44I <br /> Buckets bentoniteI go IL <br /> Depth to water 4 t"i Bags sand/gravel Co So l6 <br /> Mix Ratios Q4 K al" Filter Pack type/size Mnlav� z <br /> Installation Method-4A., v MMIC Surge Block: - 0/n) <br /> Quantity Installed 5 a a1" Discussed with geologist: - 0/ n) <br /> Type of method fq rr.a1? Yle,3c AMA �X-� <br /> EH 29 29 <br />