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MONITORING WELL INSTALLATION REPORT <br /> Date:- J U K P�_I�. Z 0 0 S CONSTRUCnON <br /> Premise Address: FiF Total Dcpth - <br /> Screen Length (from) 6o -(co)�� <br /> Well No.: M L[1 - 1 r -L r 1 U e - Filter Pack (from) -0 ' _(to) 57 <br /> Bentonite (from). S 7 ' (to) ,y ' <br /> Inspector. 1�u.,�� M Q Grout {From) 5-yt.F 1 _(to) .r�rfQ« <br /> Drilling rig type fn v ;l . a .-�'-t- <br /> Permit No 4 Z47 Auger O.D._ 8�n`•. r`fie'' I.D. <br /> Compaction - Stove pi iristie ba (circle one) <br /> Drilling Company: c�r� n tirLq ;.Th e, _ <br /> Driller: f'2 y D rCJ" ' 0 U n o__Y `J casing _ <br /> f>~ssisi4n7- I�Q us+a 5q nos �3rA►�G�trn �J'Iases <br /> '� height <br /> Consultant0 Y i 'z o n F_n _v roa r-WlIZZ W �K . <br /> Geologist ra i A ABO E-GRCttND <br /> COWLEMN <br /> SPECIAL PERMIT INFO. - Crzi sutxs <br /> Distance to sewer line J4 t 0 Qroc.K i <br /> Domestic well on site - (y/ n ) Slt <br /> 41f yes, location and distance - 7 n- <br /> 1 0 h. <br /> a <br /> SAMPUNG �loraj e <br /> ,- socicn <br /> 0 .r <br /> Holding Temperature x — <br /> Method -►= _ <br /> Screening Method <br /> Tracking Shcet - (y 1 n ) 4 _ <br /> Y ga . <br /> �tt. �_. ' <br /> NO <br /> Spoils •J „ <br /> Storage Method r MATERIALS EVELOWENT <br /> Contamination Noted - (y/ sdh !} <br /> Casing type ¢ +��`� 0 <br /> Storage Location Blank fr. Screen <br /> Slot size 02 <br /> GROUTENG Bags cement <br /> rr Euckcts bentonite ert 4 rye r- <br /> Depth to water -�e Bags sand/gravc! 3 � <br /> b ..��p ¢/� Filter Pack type/size <br /> Mix Ratios , 4 S�?c�Surgc Block: - 0/ n ) <br /> pstaHadon Method SCJ Discussed Yrith geologist: - (�/ n) <br /> Quantity Installed o2.2 r -Sm3 <br /> ---&- aa c Type of nctliod S" 4 <br /> C�n2� <br /> EH 29 29 �Q tva f l�G -0 bgrt4vri�� e - f{-a 1 GF l V a-SD ,�7` 10 <br /> s 3�8 <br /> _ h y d r 3a fps <br /> 4a' <br />