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IWNITORING WELL INSTALLATION REPO <br /> J'At - ra 't C) ajoov� <br /> Date: Many,l2 .2CONSTRUCTION <br /> Premise Address: /A Total Depth <br /> Screen Length (from) 2D ` (to) S <br /> Well No.: 5✓- / Filter Pack (from) .201 (to) ' <br /> Bentonite (from) (to) 3 <br /> Inspector: Vi e Grout (from) 3 (to) SOr q e P <br /> Drilling rig type L.,m;f-a Aeeerl 4Z;g C*1 E '7Y- <br /> Permit No. :5R -ti- L Auger O.D. /0 "' I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: �}// �B�f �}Li?alfee7�rrl� <br /> Driller: 6e,7+- S'14, /o` casing <br /> 45a7;-- a- t- -Fd,! height <br /> Consultant 15 <br /> GuistV;116- vQ ABOVE-GROUND maox <br /> COWLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surf'°' <br /> Distance to sewer line �S FP�� Qrart <br /> Domestic well on site - (y/ r� 1 3 h <br /> If yes, location and distance - tl h. <br /> N lq-- ft. <br /> ,K = <br /> Y <br /> _ O <br /> C <br /> SAMPLING - lVe sa, .5el Qs dvS-re- Co112fi�6111 Blotted _ 8 <br /> of SV-/ sac4on <br /> Holding Temperature AIX = pnvel pack <br /> Method A/,4 <br /> Screening Method /VMS- F' <br /> Tracking Sheet • (y/ n ) /I/Jf- <br /> n. <br /> SPOILS <br /> Storage Method In - rwl"fe MATERIALS/DEVELOPMENT <br /> Contamination Noted -t n ) <br /> Storage Location o»_T`fe- - prop Casingtype PYG & &Q L'- �0 <br /> Blank S- ft. Screen /-t- <br /> Slot <br /> .YSlot size QZ20 " <br /> GROUTING Bags cement�on <br /> r;s"W- Buckets bentonite <br /> all../h bd� ✓arc � ZL <br /> 2�S� <br /> Depth to water ^' /� JAS Bags sand/gravel_a "/DO /b bay Cron» ( Lly <br /> Mix Ratios -51(-2- Filter Pack type/size <br /> LYLCULVU 71Tr _ / Surge Slock: - ( y <br /> Quantity In talledaboU /Og ce_ Discussed with geologist: - ( y/Qn ) <br /> U Type of method <br /> EH 29 29 I L344 16 a ce Me t-,Ib ry 8 �kllrW o� w <br />