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Date: 418,15 CONSTRUCTION <br />Well No.: M u) 8 <br />Premise Address: 020 1elI.f5-1 teuduclar- teJ 50 /5, <br />Total Depth <br />Screen Length (from) 65' (to) 75 <br />Filter Pack (from) 43 (to) 75—' <br />Geologist <br />iONITORING WELL INSTALLATION REP( <br />Inspector: )1C,. (-4 <br />Bentonite <br />Grout (from) 0, Y ' (to) 47 <br />(from) G/". <br />Permit No. 5 R 60 7 AO 9 4 <br />Drilling Company: rik-gete-de_ <br />Driller: <br />Consultant C#P <br />SPECIAL PERMIT INFO. <br />Distance to sewer line <br />Domestic well on site - ( y / n ) <br />If yes, location and distance - <br />SAMPLING <br />Holding Temperature <br />Method <br />Screening Method <br />Tracking Sheet - ( y / n ) <br />SPOILS <br />Drilling rig type -.23',/ <br />Auger O.D. i 5 " — 5-0 /4,5 I.D. <br />Completion - Stove pipe/quistie box (circle one) <br />gr" 'Irk) <br />A <br />ABOVE-GROUND <br />OOMPLETION <br />casing <br />height <br />CHRISTY-BOX <br />COMPLETION <br />Ground Surf ace <br />grout <br />ft <br />ft. <br />ft <br />slotted <br />sec-ton <br />gravei pack <br />ft. ft <br />MATERIALS/DEVELOPMENT <br />Casing type ((Cler) ; PVC <br />Blank ft. Screen ft. <br />Slot size <br />Bags cement-- 44r i4 2 hords Cr= P,Ave z1 /4 <br />grdseriakets, bentonite <br />14/c <br />Bags sand/gravel <br />Filter Pack type/size <br />Surge Block: - ( y / n) <br />Discussed with geologist: ( y / n ) <br />Type of method <br />Storage Method <br />Contamination Noted - ( y / n) <br />Storage Location <br />GROUTING <br />EH 29 29 <br />Depth to water <br />Mix Ratios "" $ 97% loajs/35,14,0 <br />Installation Method 44e. 444,-„x d b""" <br />Quantity Installed .• 4117 ht..-t-cite5 <br />*sr — 194- rt (Vie* 4, miolic=1"'• <br />(to) Gg