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MONITORING WELL INSTALLATION REPORT <br /> Date: 7►-�." �/S CONSTRUCTION <br /> Premise Address: a2A-co U JS Total Depth / S <br /> Screen Length (from) (to) <br /> Well No.: %���-3S /Lf 6 Filter pgCk (from) /�jl S (to) <br /> Inspector: ,/ Bentonite (from) _(to) 0 <br /> Ins V• <br /> P WD'V Grout (from) /07 (to)- <br /> Drilling rig type- �'jjjUa TUDII I <br /> Permit No. �,� Q07��i7 Auger O.D. g~ I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company:_6156'6- <br /> Driller: <br /> �(—'1 casing <br /> Jfl <br /> height <br /> Consultant <br /> Geologist ARODiZI4-0 310-Q 9 <br /> ABOVE-GROUND <br /> OOWLETON CHF,IMwx <br /> SPECIAL PERMIT INFO. G=rd Surlace COMPLETION <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n ) <br /> If yes, location and distance - ft. <br /> ft. �e - ft` <br /> — a <br /> — o <br /> - u <br /> = m <br /> = r <br /> c <br /> SAMPLING slattad _ <br /> sec9on — <br /> Holding Temperature = <br /> Method = gm's Pack <br /> Screening Method =_ <br /> Tracking Sheet - (y/n) _ <br /> SPOILS <br /> Storage Method X/NS 61V S/7E-,- MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Gil/ Casing type �jC� �p f✓C-, <br /> Blank $ ft. Screen ate ft. <br /> Slot size <br /> GROUTING Bags cement_ Yf X y7 <br /> Buckets bentonite Z <br /> Depth to water Bags sand/gravel <br /> Mix Ratios (��/�7� 3b &W, . Filter Pack type/size <br /> Installation Method w'K03 Surge Block: - (y/6 <br /> Quantity Installed MY A !!17 Lt RArA!( Discussed with geologist: - & n ) <br /> Type of method <br /> EH 29 29 <br />