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3 <br /> -MONITORING WELL INSTALLATION REP{ —, <br /> Date: 4 S CONSTRUCTION <br /> Premise Address: 37-0 S Total Depth 42 <br /> Screen Length (from) 41 ' (to) 7- <br /> Well <br /> Well No.: M1.c) - 1 Filter Pack (from) 4 t' (to) zo ' _- <br /> Bentonite (from)_Zo' (to) L1.5' <br /> Inspector• , .Z�. Grout (from) i A-5 -(to) i6 C+•s'1 <br /> Drilling rig type (0 <br /> Permit No._• Od535Q Auger O.D. lo• 25" <br /> I.D. <br /> Completion - Stave pip stie box circle one) <br /> Drilling Company:� � l� 1�11.L.�S .-- <br /> Driller: RoI <br /> t casing <br /> height <br /> Consultant he_ow LL6L 1 EC'w_tta)095_ <br /> Geologist_ Irv► Lk :bn &�?� .� T <br /> r j&E-GROUND CHRMTY-SOX <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Stfacs <br /> Distance to sewer line grcxA <br /> Domestic well on site - (y/ n ) t -5 - n, <br /> If yes, location and distance - Znh. <br /> a <br /> SAMPLING slattod <br /> Holding Temperature 4by <br /> Method_ <br /> Screening Method0Lt&r_URN <br /> Tracking Sheet - Q5 / n) <br /> 41 42, tt. <br /> SPOILS <br /> Storage Method t MATERIALS/DEVELOPMENT <br /> Contamination Noted - (®/ n ) 7►c&Eo- owQ- i5 <br /> Al�SttE Casing type G SGA 40) <br /> Storage Location O <br /> Blank -- � ft. Screen ^Zz ft. <br /> Slot sizedn I Mao" <br /> GROUTING Bags cement BM04.tm - <br /> Buckets bentonite ► <br /> Depth to water '- 30' Bags`FWgravel t0 <br /> Mix Ratios 4°1v P,cntonha.l C.m , Filter Pack type/size •Stun.. vt $ <br /> Installation Method Surge Block: - qV n ) <br /> Quantity Installed ti h Discussed with geologist: - )/ n ) <br /> la Type of method uM <br /> EH 29 29 <br />