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WNITORING WELL INSTALLATION REPO. <br /> �GGIt/G2fL t /3,J b�"e- /'La Ae- <br /> ,sh�r/� <br /> Date: mar6 , 0/r .21) /-9 CONSTRUCTION LJ�J dt�,el�. <br /> � _ r <br /> Premise Address: AGO / /Urn,o k,_ Zd Total Depth o2D �trk6S, <br /> — <br /> Screen Length (from) (to) <br /> Well No.: ✓ 3 — b r' — Filter Pack (from) (to) <br /> made, in -o SV rd tc4al Bentonite (from) (to) <br /> Inspector: �j Gk 0yln.�alrFn e u Grout (from) 20Drillg rig type <br /> Permit No. .SR 00 145-0 L 7 Auger in <br /> /0"I m} I.D. a.ems 7S <br /> pp Completion - Stove pipe/christie box (circle one) <br /> Drilling Company:_�{jl Wp)I /i,ba nn rn .� <br /> Driller: Idb&ir+ sl casing <br /> fFssisfo Stan Schoen height <br /> Consultant !fid Van t �r@�67i/✓Irnitch fie, <br /> c --ca�t.�Qr7� �� (/a�lldnUe ✓a - t�Cr� - <br /> e n4e) ABOVE-GROUND ckwisrraox <br /> COMPLETION <br /> COMPLETION <br /> SPECIAL PERMIT INFO. G=nd Surface <br /> Distance to sewer line grout <br /> Domestic well on site - (y AZO <br /> If yes, location and distance - tt' <br /> ft. <br /> tt. <br /> — a <br /> = m <br /> SAMPLINGe <br /> So. GhY��a w"Y�r �f P/ D d't <br /> a-7.0(a-7.0( 2U 'bJ4slotted = c <br /> jV tacton S <br /> Holding Temperature pYt2 lad-r ekWe <br /> vel Pack <br /> Method L✓d✓pgr71 r/f _ �' <br /> Screening Method uj, av1 <br /> Tracking Sheet - (y/ n ) jk- — <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type IVA <br /> Blank A047 ft. Screen Nt+ ft. <br /> Slot siz — <br /> GROUTTNG Bags cement 8 94/b Awade Tiv_�e r-I� <br /> Buckets bentonite At e-*rew'f <br /> Depth to water > 3 0 bsg Bags sand/gravel Al A- <br /> Mix Ratios 7 Filter Pack type/size IV."+ <br /> Installation Method Surge Block: - (y/ n ) PVA— <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> Type of method �l/y <br /> EH 29 29 "� / <br /> OVA- —M,+ 4d2f `e4L)e, <br />