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ITORING WELL INSTALLATION REPOR <br /> f f <br /> Date: -'Sa.., 19 t '2— CONSTRUCTION <br /> Premise Address: ¢Z5 t� Un L Total Depth <br /> Screen Length (from) (to)_S <br /> Well No.: kk W I Filter Pack (from)_ -75 _ —(to) <br /> Bentonite (from) (to) <br /> t Inspector. f1 - Grout (from) e YL (to) <br /> Drilling rig type h <br /> Permit No. �f l _ Auger O.D. D I.D._-,(n V <br /> { Completion - Stove pip uistie ox circle one) <br /> Drilling Company: <br /> Driller: cas Ing <br /> T- <br /> Geologist <br /> he;gEttConsultant r Le Y1L F ,� 9. , : . _ 7', <br /> ABOVE-GROUND GiR15TY�OX <br /> COAF'LE?fON - COMPLETION <br /> SPECIAL PERMIT INFO. GrourdS+face <br /> r c <br /> Distance to sewer line V l �� �fO� <br /> Domestic well on site - y n) <br /> If yes, location a�d ista ce - M <br /> SAMPLING - :lotted w + <br /> : <br /> &4K I= <br /> Holding Tem ergture <br /> 9MV1W Pack <br /> Method UG <br /> Screening Method D <br /> Tracking Sheet - (y//n -Y <br /> SPOILS f r ,f-(�,4 �{ -. <br /> Y Storage Method [kms I ( V JWIj MATERIALS EVELOPMENT <br /> Contamination Noted - / ) G !' �( Sc Ln 40 Storage Location Casing type <br /> Blank J 5-h. Screen Za ft. <br /> Slot size 0 <br /> GROUTING Bags cement ars. <br /> Buckets bentonite 5 <br /> Depth to %vater Bags sand/gravel <br /> Mix Ratios CM 13 Filter Pack type/size YMo 46 6ZZ/? <br /> Installation MethodJ Surge Block: - (y/ n <br /> Quantity Installed ParK U1 1106, Discussed with geolo is t: - �n ) <br /> 5 tog d�5 tv�5 d �PR� Type of met23od��y�d rk �tcE fie <br /> EH 29 29 ��I�UrPI?cu7 t" oval tIbu- <br /> 11 GrvMS Soli �- <br />