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MONITORING-WELL INSTAUATION REPORT <br /> Date: _�n`i h y.��j/ �� 2oDCONSTRUCTION <br /> Premise Address: O j Total Depth Sol <br /> Screen Length (from) 30 , (to) U <br /> Well No.: M L-) - Filter Pack (from) '3A (to) A ' <br /> Bentonite (from) A ' (to) 6 ` <br /> Inspector. VitL'u rnC�CFlY — Grout (from)_ __(to) surfaeL. <br /> J Drilling rig type_ ;/ & <br /> Permit No. 2 17 / Auger O.D. z <br /> a 4,.. -- <br /> y Completion - Stove pipe/ uLsde box circle one) <br /> Drilling Company �Yry,1 i�2 121/!rO�z�1t P�rcLQ <br /> CP IGi an9� /liar��I CeJ� —� casing <br /> Driller: Juan V 1 height <br /> Consultant AC(5 <br /> Geologist J) n h nam Gm Jo L C rngn A!;;vE-Gawp vnnaox OOWLET*N <br /> Grou <br /> SPECIAL PERMIT INFO. nd Sxa � <br /> Distance to sewer line <br /> G ,S Few �rrs? i o`�K <br /> Domestic well on site - (y/0- Il' <br /> If yes, location and distance - ft' <br /> .L—.ft. <br /> - c o <br /> = a <br /> ilonod � <br /> SAMPLING socicn = <br /> Holding Temperature eOo / j, <br /> Method <br /> Screening Method — <br /> Tracking Shcet y I n) r _ <br /> SPOILS <br /> Storage Method ✓r !U B MATERIALS/DEVELOPMENT <br /> Contamination Noted- fo Casing type ¢)'/L <br /> Storage Location — Blank , /d fr. Screen /0 - 30 R <br /> Slot size D D <br /> S 7L <br /> GROUTING Bags cement <br /> Buckets bentonite_ %z b <br /> Bags sand/gravcl 3 <br /> Depth to water p Z -/z <br /> Mix Ratios ^' X /6,aPw-��r•� Filter Pack type/size �K 3 a <br /> dpstallation Meth d _ Surge Block: - tt ) <br /> Quantity Installed ?/ e � � Discussed vrith geologist: <br /> C _ Type of ncthod surae <br /> nBLlf;s <br /> EHa929. Li1Jtn <br /> Do I bsL b <br /> R�„ i� Yt;te- �Vt�PS '50blb"�j"e� � �0 �t' <br />