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• rv'r'IITORING WELL INSTALLATION <br /> T <br /> Date. a"2-3-Oct <br /> CONSTRUCTION <br /> I Premise Address:-15oo skAAj '�-4r Total Depth <br /> �(CC ;k _ Screen Length (from) to /S <br /> Well No.: Tom-Z-� Filter Pack - (from) (to) to. <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> G Drilling rig type GM-E <br /> Permit No. �i'U��B J� k " Auger O.D. I.D. - <br /> /J _ Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> s .. height - ! <br /> Consultant Ti45. <br /> r � { <br /> / <br /> Geologist C-�a0"t� (��w�� - •- - - <br /> - ABOVE-GROUND <br /> COMPLETIO <br /> N <br /> CHRISTY-BOX <br /> O <br /> COMPLET70N <br /> SPECIAL PERMIT INFO. + (around Surtact <br /> Distance to sewer line grout <br /> RO <br /> Domestic well on site - (y Q 1 (op <br /> If yes, location and distance - yj4 ft. <br /> _ O <br /> SAMPLINGys slotted _ c 1 <br /> Holding Temperaturei(/O 6;a. rfu4 g,vslPack <br /> Method.. <br /> Screening Method — ,- <br /> r. <br /> Tracking Sheet - (y/ n ) <br /> SPOILS' -\ �� -.- �^r `v.R....��. �f+ ^*,: ",,+�2,_- .t •' . �+; i I <br /> s Storage Method fes' " MATERIALS/DEVE <br /> LOPMENI <br /> Contamination Noted - (,1 n �� ' x _ _ 24 A 46 IPvC • I <br /> Storage Location . ry'-- 'u Casing type <br /> �G- <br /> � '` = �c `. � .m� Blank fti Screen " S ft: <br /> Slot size 01 ` i. <br /> GROUTING , F p r` Bags cement <br /> a .r 4Y • -r .. ... <br /> Buckets bentonite & <br /> Depth to water X59 : * " �� - 'a : Bags sand/gravel T' 3 <br /> Mix Ratios +, Filter Pack type/size 12- <br /> Installation <br /> 2Installation Method S ! - `Surge Block:` (`y/ n.) : <br /> Quantity Installed' Discussed with geologist: = (y/ n ) <br /> Type of method ^' <br /> ,EH 29 29 <br /> e4 <br /> l 't,s <br />