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MONITORING WELL INSTALLATION REPORT <br /> Date: - I Z CONSTRUCTION <br /> Premise Address: 1W( TURNC��KE ��/, Total Depth 45 ' <br /> © Screen Length (from) Coo (to) Cos <br /> Well No.: —�� d 'f' Filter Pack (from) f7 (to) Ge <br /> ( �`� Bentonite (from) S4( (to) Is- <br /> J— _ <br /> Inspector: o Igl(w I Grout (from) o ` (to) S ZC <br /> Drilling rig type_ RoT*e(j <br /> Permit No. Slot( Auger O.D. $ �� I.D. T <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: j4" GdE« 9�d3l9NIb0/V{'l',(cyt' <br /> Driller: MI(oa6j, SEJf} p je>v E 56fig 457Ah) casing <br /> height <br /> Consultant DRAI 1(=LU/1.1.,aMdFusJ --AGF /NC' <br /> Geologist DAAl46-4- V(LU¢A)"OQ <br /> ABOVE-GROUND C✓•4iISTY-BOX <br /> COh4�LETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surf <br /> tt� <br /> Distance to sewer line ti 7 grout <br /> Domestic well on site - (y rf 1 s C n <br /> If yes, location and distance - <br /> n. <br /> n. <br /> — a <br /> q <br /> q <br /> _ C <br /> SAMPLING dotted <br /> taction <br /> Holding Temperature <br /> Method = P <br /> Screening Method • <br /> Tracking Sheet - (y/ n ) <br /> SPOILS <br /> Storage Method ROLL ,PE-N pc'mPAE:k 2 WL MATERIALS/DEVELOPMENT <br /> Contamination Noted - (Cyd' n ) <br /> Storage Location ANT 1'146K(tie-L.oY- Casing type / PUe <br /> V Blank___( o ft. Screen 5 ft- <br /> Slot size rC,& Pat <br /> GROUTING Bags cement P (9Y'kB< <br /> i Buckets bentonite /• SoLBs <br /> Depth to water ^ 7 Bags sand/gravel F/- Zno c8s <br /> Mix Ratios 50-glgLL 1Filter Pack type/size "e?S9rub <br /> Installation Method P!Lwi Pa T2tNr IE bme Surge Block: - (yrn'b <br /> Quantity Installed b0uw75 Discussed with geooro--gest: - (y n(' <br /> Type of method <br /> EH 29 29 <br />