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r <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: /VbVPwly k ,z2. aoo 4 J CONSTRUCTION <br /> Premise Address: 1601 TUrn p;L ice. Total Depth 3S� <br /> Screen Length (from) 3S' (to) /S ' <br /> Well No. mLJ _Z an'd- -41W Filter Pack (from) 3. ' (to) /3 <br /> Bentonite (from) /3' (to) <br /> Inspector. Vl ' { �� Grout (from) - // ' (to) -cv�F� <br /> Drilling rig type e-)W LE `J� <br /> Permit No. TJ D t D 37 I Auger O.D. A )n jT4 I.D. 4, 2s"'yy�� Completion - Stove pipe/ ne o . (circle one) <br /> Drilling Company'. <br /> Driller: �VQ/II �2 IGf07�g�� Fm —a- casing <br /> he-ight <br /> Consultan <br /> Geologist <br /> A.AVECKRZTY-BOX/ -G1CUN <br /> XWLETION <br /> SPECIAL PERMIT INFO. --G=nd Sutace <br /> Distance to sewer line i <br /> Domestic well on site - (y/(D <br /> If yes, location and distance - I ,� 3 ft. <br /> - C <br /> O <br /> SAMPLING slon� <br /> soden <br /> Holding Temperature n k" _ Facx <br /> Method N2_ 110o 1 <br /> Screening Method _ <br /> Tracking Sheet -Un ) <br /> 3 " — <br /> S <br /> n. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( n) P,/I+ S Ed�u�Q � <br /> Storage Location t91t? a�1 Casing type C� <br /> Blank_n I S ft. Screen IS - 3S h <br /> Slot size Z <br /> Bags cement 3 r <br /> GROUTING <br /> Buckets bentonite 1 - S U �� <br /> Depth to water Bags sand/gravel 1' / 2 to <br /> Mix Ratios { J fPr { �� Filter Pack type/size <br /> l <br /> 4pstallation Method �� /Surge Block: -�/ tg) <br /> Quantity Installed s/,discussed vrith geologist: - n) <br /> W 7 t`` Type of nethod 5 u Ana- bla <br /> EH 2929 MW-.Z - USeq/ y006)� #k3sarre <br /> mew-3 vse_� 42s 5 on-A) #3a <br /> -12- so-x <br />