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MONITORING WELL INSTALLATION REPORT <br /> Date: 3/»1N)5 CONSTRUCTION <br /> Premise Address: OP &V7- "41Y gvPN4r0 Total Depth -d 55 <br /> ew Screen Length (from) X50 (to)-- B3_v <br /> Well No.: Filter Pack (from) -d 4w (to)-_, Z7 <br /> Bentonite (from) - d 17 (to)-902 <br /> Inspector: .17 Grout (from) dol (to) 0 <br /> Drilling rig type�i�q /1/g. ✓/to ANG <br /> Permit No. Auger O.D. toY <br /> j' 1 I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: 4,4t64- *W VI,rT ,l <br /> Driller: �olir.�� G,GPqurtf casing <br /> i <br /> V height <br /> Consultant_ 4,te-O /S 4•S �^�L <br /> Geologist ✓I^0 /044,A/ .r / <br /> ABOVE-GROUND <br /> COPrr LET;0N Cf-IMM-BOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. pmund Suiace <br /> Distance to sewer line A&k Grp <br /> Domestic well on site - (y/d9) e.Yy w4-fe✓ 209 ft <br /> If yes, location and distance - <br /> a l ft. <br /> = m <br /> = m <br /> SAMPLING ✓�fi = c <br /> 0 <br /> slottad � <br /> 7p� sac- on <br /> Holding Temperature = <br /> Method = VI"OI Pack <br /> Screening Method = <br /> Tracking Sheet - (y/n) <br /> tt. <br /> 5� <br /> SPOILS d��p <br /> Storage Method Y�y.l golI MC /y✓S MATERIALS/DEVELOPMENT - afro <br /> Contamination Noted - (y <br /> Storage Location **_VfP Casing type Ste q0 01' <br /> Blank a35 ft. Screen 80 ft. <br /> Slot size 0•. rwt, <br /> GROUTING Bags cement go <br /> Buckets bentonite lw <br /> Depth to water Wtik Bags sand/gravel_ a y S1 bs hea s #3 <br /> Mix Ratios g 471k, btps� 30 pJ46c . h„d>t,, Filter Pack type/size <br /> Installation Method hiKO i20r-I" Surge Block: - (y/ ) <br /> Quantity Installed Discussed with geologist: - (�/ n ) <br /> Type of method <br /> EH 29 29 <br />