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�IITORING WELL INSTALLATION REPOE6 <br /> Date: ��` ;27-D CONSTRUCTION <br /> Premise Address:—./6 b�l K&- 7, Total Depth �.52 <br /> Screen Length (from) 3 (to) <br /> Well No.:- 1/y` S Filter Pack (from) 3r(to) /3 <br /> / 1 Bentonite (from) / (to) <br /> Inspector. T'61" M&-/no r �- Grout (from) /' (to) Surfae <br /> Drilling rig type <br /> Permit No. f�0¢ �'��7 Auger O.D. I.D. <br /> Completion - Stove pipe/ is a ScircIe one)\ <br /> Drilling Company: ��eSl��i J) )-'4 �� i ti <br /> Arev/e5 <br /> Driller: lb! t1 S/1 �/J zG/r- d� li=<�i/is/�7rsf r height <br /> � _ '� ,QY;CfitiRlGl�j T height <br /> Consultant A G J��fin Gutier <br /> Geologist V)�4 1-eL _ _ r_ T <br /> OVE <br /> CONFLETION <br /> r! �tct��s i C� �UGi q e -GROUNO CtiA <br /> cJ d COMPLETION <br /> SPECIAL PERMIT INFO. G=ndSudan <br /> Distance to sewer line grout / <br /> Domestic well on site - (y ZU 7 ft. <br /> If yes, location and distance - ft. <br /> nA _• _ 0 <br /> Q <br /> SAMPLING dorm <br /> Holding Temperature aC = ]if,. <br /> Method : <br /> Screening M thod i v <br /> Tracking Sheet - n) I � Y /0� /S - <br /> tl. <br /> SPOILSI GC/ItJI �y !�b�r3s / <br /> Storage Method GAYy mJ MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/rn <br /> Storage Location_ r f e Casing type 4o <br /> Blank 4 5 ft. Screen at) ft. <br /> Slot size /) , °�l e <br /> GROUTING Bags cement 04 <br /> Buckets bentonite � 4 #0 <br /> '^ fir✓� <br /> Depth to watera"x c Bags sand/gravel <br /> Mix Ratios - N J Et 1f7A Filter Pack type/s;z r 3 A <br /> Installation Method rr� Surge Block: - ( /n <br /> Quantity Installed - a k2pyF CvNe -Discussed with gco ogist: - (y/ <br /> Type of method <br /> EH 29 29 -A-6-rt grb bP4� Nl �✓ 7 <br />