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} 7NITORING WELL INSTALL TION REP"O'+� <br /> Date: S- [3 <br /> CONSTRUCIZON <br /> Premise Address: Toth Depth �Q 11• �J <br /> 1 Screen Length (from) 9q- 5-- (to)_ J007-f-- <br /> Well <br /> 007.5 .Weil No.: I 2 Filter Pack (from) fit. 5 (to}5=" <br /> Bentonite (from) '�X'- -_-- (to)+„ C, - <br /> Inspector. Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. S I.D. ` <br /> Completion-Stove pipe/ ircle one) <br /> Drilling Company: �Lltvt <br /> Driller. CIA to US SGJ S cas inq <br /> he s ght <br /> Consultant e <br /> 74 T <br /> k Geologist �L wt�✓e-� <br /> 4 ABOVE-GROUND CHRMrr-aox <br /> a?.&FLEr,CN caWDL_mcH <br /> SPECIAL PERMIT INFO w Ground suf'ce <br /> Distance to sewer line <br /> Domestic well on site - (y/ n �' .fL <br /> If yes, location and distance - , <br /> K. <br /> Y � <br /> yr r <br /> SAMPLING ,. _ . tbra i <br /> socicn -K <br /> Holding Temperature vA, ,�_ grsval park <br /> Method 11 L^U s ked JU_ I- - _ <br /> Screening Method DO ILA <br /> n <br /> Tracking Sheet y a) — w <br /> SPOILS <br /> �- Storage Method KJ d MATERIALS EVELOPMENT <br /> Contamination Noted - { y/ <br /> Storage Location Casing type 2" PJC <br /> Blank q' S fr- Screen ft- <br /> - �}ez�+rn5 5�ncls P,vicaun c d 1 Slot size Z° <br /> GROLMING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel C 10 119 <br /> Mix Ratios Filter Pack typ e <br /> Installation Method Surge Block: - W n ) <br /> Quantity Installed Discussed with geologist: - (y/ n } <br /> of Type of method- <br /> EH <br /> ethod EH 29 29 5 &Pw- � cir5 Iii <br /> It `nor+ <br /> tc- to Pep <br /> 21.5 (.pprn <br /> 21a Lppm <br />