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ONITORING WELL INSTALLATION REPO* <br /> Date: [�- 2 7 - 0 L CONSTRUCTION <br /> Premise Address: ` ` �UYrt ip� {� /�d. Total Depth �s <br /> Screen Length (from) 357 (to) l5 ' <br /> Well No.: hd W ^t'i Filter Pack (from) (to) /3 r <br /> Bentonite (from) /3 (to) <br /> Inspector. V11C1 1" &o Grout (from) (to) dr <br /> Drilling rig type - <br /> Permit No. 004' 8 8 F'P Auger O.D. f,00 ' I.D. � <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: G75cltU��'- <br /> Driller: To rV gs/L1 d oar -6 I�� casing <br /> (3rett- remes1 ('J'/r�S l//irlSf Bn height <br /> Consultant A G E <br /> Geologist ra)VIn Led_ Bob /yiariN� %e. <br /> A l l �� Col a v e tQ Jess 4& R✓�9 e �itR-rt�oNG c}MM-Box <br /> I coMat._mo <br /> SPECIAL PERMIT INFO. Ground S "y <br /> Distance to sewer linek n o elan _ gra <br /> n <br /> Domestic well on site - (y/0 - fto <br /> If yes, location and distance - }t, <br /> C <br /> SAMPLING dorsi <br /> tocicn =_ <br /> Holding Tempe{ature 46 _= ¢avel pack <br /> Method ice l » Y'eolPr <br /> Screening Method D . <br /> Tracking Sheet - y n) <br /> all No <br /> SPOILS / <br /> Storage Method �_=; urnd-ct;rS.fe MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y <br /> Storage Location Casing type -2 <br /> Blank Screen .2_6ft. <br /> Slot size 2- <br /> GROLMNG Bags cement 7 - 7-f- <br /> m/�/cvm Buckets bentonite / - 42Y--e-66o(e1 Sm <br /> Depth to water 13R, 5 �rY Bags sand/gravel /&,o11_y,Pfi <br /> Mix Ratios '7 - 0 /6rl rIle,0 Filter Pack type/size 1 <br /> Installation Method -FY Surge Block: - ( y&2A <br /> �) <br /> Quantity Installed - Discussed with geo ogist•. - ( y'lJ <br /> Type of method <br /> EH 29 29 <br />