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%.wMONITORJNG WELL INSTALLATION REPVv& 2- o , 2- <br /> Date: 1 2 3 1 0 CONSTRUCTION <br /> Premise Address: (n'1jK S k'2' 2-'.VC Total Depth <br /> Well No.: a— Screen Length (from) I I (to) IA' <br /> Filter Pack (from) Q- _,(to) Z6 <br /> Bentonite (from) <br /> Inspector. Grout (from) <br /> Drilling rig type <br /> Permit No. 52 0 CJ X I Irz Auger O.D. I.D. <br /> Drilling Company-.J�e:z W'C'A Completion -Stove pipe/cluistie box (circle one) <br /> Driller: casing <br /> height <br /> Consultant <br /> Geologist VA <br /> ABOVE-GACQN0 C4--RZTY-Z0X <br /> 00kPLETION CO&VILEMN <br /> SPECIAL PERMIT INFO. G=nd SLjrlw* <br /> + <br /> Distance to sewer I' <br /> ineprcut <br /> - <br /> Domestic well on y J n <br /> 11"yes, location distance - <br /> SAMPLING <br /> W-2— <br /> socicn <br /> Holding Temperature <br /> Method gnVol Pack <br /> Screening Method <br /> Y/ <br /> Tracking Sheet <br /> y/ n ) <br /> J, <br /> 7� <br /> SPOILS <br /> Stora Method MATERJALS,�2EVF-j,OPMF-NT <br /> 1�1 <br /> amination Noted y n <br /> Co�o amin' <br /> St/rage Locationev <br /> Casing type <br /> Blank ,I fL_ Screen <br /> 2ROLMNIG Slot size-- 0-7-0 <br /> W JXUA. Bags cement <br /> Depth to water Buckets bentonite 2, <br /> Mix Ratios Bags sand/gravel -I- <br /> Filter Pack type/size—AA--3F' <br /> InstallationMeth Surge Block: - (y <br /> Quantity lns�ta IeTl <br /> Discussed with gcoIogtst: y <br /> EH 29 29 Type of method <br />