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iMIITORING WELL INSTALLATION REPOR k <br /> Date: U OD .m CONSTRUCTIONrnuj- <br /> r . ` <br /> Premise Address: "S: �,,/." W' � ' �� Toral Depth <br /> Well No.:__AZ[ (P Screen Length (from} 3 3 (to)_ 55 <br /> e _F <br /> f ` "" "` '-. .-4ilteiPack. „ (from) 5 'S (to) 8�L_k <br /># e 4 Bentonite (from) 3 t' (to) Z,9 ' <br />;. Inspector. �3: , - -*Grout .:,.�_ _ _ (to) t <br /> - (from) <br /> ' L-. 'Drilling'ng type r� <br /> + = s R T k,F Aug" O.D. :D. 5 <br /> Permit No. + <br /> Completion - Stove cristae box circle one) F <br /> Drilling Company: s. ,. . .- <br /> Driller: 1 V�-�.i� a� ����� n`s"--•._ '"-*�' � � <br /> ^ - casing47 <br /> .,..: <br /> height <br /> 'Consu — ITt. <br /> Geologist U w s <br /> -ABOVE-GACUND } <br /> CFMSTY-BO } <br /> SPECIAL PERMIT INFO. nd Shy <br /> . Distance to sewer line r - � -~ ,. '.. m � 4rout , .: �-w <br /> Domestic well on site - (y <br /> If yes, location and distance' It. <br /> SAMPLING _ o <br /> 0 secycn <br /> Holding Temperature — <br /> Method ., .. = 71 WPack <br /> �h <br /> Screening Method t '' <br /> Tracking Sheet - (dyy n ) ,. . .. '. ' <br /> Ecol-Jr ' � • - - �1p - t __R -- "�_.(t. '� - 3 ,:n• _ i. <br /> SPOILS <br /> Storage Method ,.MATERIALS EVELOPMENT <br /> Contamination Noted - ( n } W NDrL 9 tl) <br /> Storage Location i a„ Casing type 4q JV Lt <br /> Blank *33 fr- Screen U> ft. <br /> Slot size o _(5zQ <br /> GROUTING Lugs cement LD A,Av } <br /> Buckets bentonite <br /> Depth to water� tr NL. 3Le Bags sand/gravel N <br /> Mix Ratios -.Filter Pack type/size 3 <br /> Installation Method_ T- fLgam- :,Ac`c;. Surge Block: - (y <br /> Quantity installed -Discussed with geolo ist: -0/ n ) <br /> Type of method <br /> EH 29 29 <br /> ;R t <br />