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4�it <br /> UNITORING WELL INSTALLATION REPOT ,,J <br /> I�r - <br /> i+ V <br /> Dace: "LA-A. '� I�C�L3 CONSTRUCTION <br /> dr tlect ao5a <br /> Premise Address: oca SI1'JLQ�' _ Total Depth 4 2 C hea�in� Se vt S <br /> Screen Length (from) 4 2 (to) z 2 <br /> Well No.: MW 1 XTt-I Co (b) Filter Pack (from) 42- (to) 2� <br /> Bentonite (from) 2n (to) 1"4- <br /> Inspector. Grout (from) 1-7 (to)___a_ <br /> D Drilling rig type GME <br /> Permit No. �. D Auger O.D. `3 I.D. /c[ <br /> '' dl Completion - Stove pipe/dtrisde box (cir�e) <br /> Drilling Company �l�Si L�ll�t� <br /> Driller: Le-0 6 LuC ,rlcasing <br /> �� height <br /> Consultant kUa Cs20sclevtces <br /> Geologist UULc4 C.y)C ✓LTL <br /> ABOVE•GRCUND CHR MTY-BOX <br /> OOMPLETCN COMPLETION <br /> SPECIAL PERMIT INFO. Ground Saiacr <br /> I <br /> Distance to sewer line areut <br /> Domestic well on site - (y/(g) <br /> ft. <br /> If yes, location and distance 2ZR. 7 F- <br /> SAMPLING .lonad — c <br /> +ocicn <br /> Holding Temperature <br /> Method tu cAk5 P'L`US Gam ! <br /> Screening Method 1=th'i : — <br /> Tracking Sheet - �/q>/ n ) <br /> a. ft. " _ Z tL <br /> -- I <br /> SPOILS <br /> Storage Method MATERIALS/DEVEI.OPMENT <br /> Contamination Noted - Olt No UG <br /> Storage Location QM S Casing type �n <br /> Blank 2 Z ft. Screen_-Z0 ft. <br /> Slot size D-LD <br /> GROUTING Bags cement <br /> Buckets bentonite�/L CkIps Hz cw � <br /> w <br /> Depith to water �� Bags sand/gravel (n `i, <br /> Miz Ratios Filter Pack type/size 112- <br /> nst <br /> allation Method Surge Block: - <br /> Quantity Installed Discussed with(geo/ <br /> t: n) <br /> Type of method <br /> cydhval_ <br /> EH 29 29 <br />