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MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address : 70s--b f Ceyw�, 4- Total Depth SS <br /> Si CIC- .,,_ , cf' Screen Length (from) UD (to) ST <br /> Wel] No. : MuJ - 2 3 Filte-r Park (from) (to) ST <br /> Bentonite (from) ? (to) <br /> Inspector: '� y ,��[ , n Grout (from) G . T (to) 3 <br /> Drilling rig type_4^ <br /> Permit No, Auger O,D. R . zr LD._ <br /> Drilling Company: P1VJ A Completion - Stove pipe/christie box (circle one) <br /> . <br /> Driller: J Ja^ C: H '� casing <br /> height <br /> Consultant_ DC7 is <br /> Geologist <br /> ASOV&GROUND <br /> COMPLETnN o T �� 2TY--Box <br /> , <br /> SPECIAL PERMIT INFO. Sucixe <br /> Distance to sewer line out <br /> Domestic well on site - ( y nn <br /> If yes, location and distance= 3 3 ft. <br /> 40 ft. <br /> ft. <br /> SAMPLING sb tad > <br /> Holding Temperature = <br /> Method gni Pack <br /> Screening Method <br /> Tracking Sheet - ( y / n ) <br /> It <br /> SPOILS <br /> Storage Method `pH MATERIALS/DEVELOPMENT <br /> Contamination Noted - OP {gyp <br /> Storage Location D, i� Casing type �Eln q PU C— <br /> Blank— 90 ft. Screen jT' ft. <br /> Slot size 6 .0 d <br /> GROUTING Bags cement <br /> Buckets benton to <br /> Depth to water y D Bags sand/gravel <br /> Mix Ratios ( l n✓ 5�1 bs �owT Filter Pack type/size mW <br /> Installation Method leyh� �' J�— Surge Block: - ( 'y / ) <br /> Quantity Installed Discussed with geologist: - n ) <br /> Type of methody <br /> EH 29 29 <br />