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MONITORING WELL INSTALLATION REI-...-f <br /> Date: 'd CONSTRUCTION <br /> Premise Address:_ 3 S io o N wy 3 3 Total Depth 6q, <br /> Screen Length (from) 119 ' _(to)�� 9' <br /> Well No.: C`x 7S-C'c 7'�7 c." tt-)e (/ Filter Pack (from) (to)- Z/' ' <br /> Bentonite (from) Y7 (to}. <br /> Inspector: (Z ' yz Grout (from) 1Z (to) <br /> Drilling rig We ho//o,- spm 4 S <br /> Permit No. y -7i Auger O.D. /0 " I.D. <br /> Completion - Stove pipe/chri tie box (circle one) <br /> Drilling Company: (-2 C o Sia <br /> Driller: casing <br /> height <br /> Consultant b r VIV Gc'o Syk c 7 ♦ r <br /> Geologist �J�vi�� G✓c'�s - �� <br /> A3CVE-GRCl1N0 C1--iS S,Y-3CX <br /> Grll�t�i CN C MP=='1CN <br /> SPECIAL PERMIT INFO. S�'c' A <br /> Distance to sewer line (.tk prat e <br /> Domestic well on site - (l/ n ) ♦ K. <br /> If yes, location and distance - - �c� tL <br /> L-1 l e x�-u c/7u- <br /> 73 <br /> a <br /> SAMPLING - C u H, v s1 1 S o l% sa ft�v �4— <br /> sedan <br /> Holding Temperature 7a,r01 pack <br /> Method <br /> Screening Methode <br /> Tracking Sheet - ( y/ n ) ' <br /> -L UE41 <br /> SPOILS <br /> Storage Method $ e z S S ;J`` - MATERLALSADEVELOPMENT <br /> Contamination Noted <br /> Storage Location D n S i Casing type ,WC (, <br /> Blank L/� fc Screen <br /> Slot size_ , a j <br /> GROUTING Bags cement a5 Aa s <br /> Buckets bentonite Z c s <br /> Depth to water a 8 Bags gravel <br /> Mix Ratios 3 4"� SS ``` Filter Pack type/size � <br /> Installation Method Surge Block: - C Y/0 <br /> Quantity Installed 'Q� 5e - Discussed with geologist. - 6/ n ) <br /> EH 29 29 <br /> g Type of method <br />