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ONITORING WELL INSTALLATION REPO* <br /> Date: /�'" 7"a L CONSTRUCTION <br /> Premise Address: 1601 /U1 fl ket X41 Total Depth <br /> Screen Length (from) 35- (to) <br /> Well No.: M W- 7 Filter Pack (from) 3.�' (to) J3' <br /> ./ Bentonite (from) !R ` (to) / L r— <br /> Inspector. Vito me(A Grout (from)��.(to)—S&r-( e <br /> -ae <br /> �— Drilling rig e e M E <br /> r^ Dr' 1i1S <br /> Permit No. 0-4 S '7 Auger O.D. r I.D.I.D, <br /> Completion - Stove pipe/�isde boz%(circle one) <br /> Drilling Company: D.swje' <br /> / Oreff Are,ne's <br /> Driller: 7 r v I Zkr eti1l' C'hr s )t/ nS * casing <br /> fRrian hiC�L -Y rAra/ i{I�� height ZON <br /> Consultant AeEGeologist ce /Vi v. L ee- <br /> RIIj Ccl9 v; tcJe ;c � � CONF ETIOND <br /> SPECIAL PERMIT INFO. Grsurd Sufwt <br /> Distance to sewer line b Y1 Krt 0&0 a PIZ, <br /> oroaII <br /> Domestic well on site - (y/ n) <br /> If yes, location and distance - ft.tt. <br /> q 0 <br /> a <br /> — c <br /> — C <br /> SAMPLING doted <br /> 9 C —_ <br /> Holding Temperature �}n� _ Pavel Fade <br /> Method c i n Cool"„— <br /> Screening Method P 1 T) r <br /> Tracking Sheet - (yY n) P 1 D r a 5 -PS; /0' /5 ' <br /> z6'1 <br /> ) .2,�,' -all qID 3.S g, <br /> SPOILS <br /> Storage Method 5S d4'jjni. AYu rn.S aris'� e, MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/® <br /> Storage Location o-t 5 r1 c Casing type -2 F Sc Pe�1 e <br /> Blank i ft. Screen 4 <br /> Slot size U 02-' <br /> GROUTING Bags cement - <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel 14- sd11✓ 1 _t2w l,v}rc <br /> Mix Ratios C?Lc # (-L-t z Filter Pack type/size ,3 <br /> Installation Method _ Surge Block: - ( y/0 <br /> Quantity Installed 4 - T Ell•-U Discussed with geologist: - ( y <br /> tti Cry � e� Type of method <br /> EH 29 29 4- ro v+ . <br />