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1 <br /> MONITORING WELL INSTALLATION REPORT <br /> Date:_ 1 -2 1 -14 CONSTRUCTION <br /> Premise Address:_ Lo$ Q o.a o ptti� S¢. S. �� Total Depth_ f, <br /> Well No.: t\kw -�Z spy. Screen Length (from) 5^S"-- (to) G 3' <br /> Filtar Park rfr ml S" r+ <br /> Inspector: \Ab�L'> 'V, Bentonite (from) S-D (to) <br /> Grout (from) 0, f (to) SY <br /> Drilling rig typeSI .L <br /> Permit No. Auger O.D. 9. t r- I.D. S <br /> Completion - Stove pip stie box (circle one) <br /> Drilling Company: <br /> W06d uxlv) D r i 0/1-1 <br /> Driller: lDcw{. V41-,$1Cy h <br /> �(`� casing <br /> height <br /> Consultant ' <br /> Geologist CWI ut'y <br /> ABOVE-GROUND <br /> M,FLETCN CNR1M-&O- <br /> SPECIAL PERMIT INFO. COMPLET1ON <br /> C3raur,�Surizce <br /> CIA- <br /> Distance to sewer line o grout <br /> Domestic well on site - (y/ <br /> If yes, location and distance - <br /> �s <br /> f?.ft �_ - <br /> = m <br /> = m <br /> SAMPLING — o <br /> slotted c <br /> sermon _ <br /> Holding Temperature •y. Lot( — <br /> Method N = gravy pack <br /> Screening Method <br /> Tracking Sheet - /n) <br /> SPOILS <br /> Storage Method MA.T'ERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n <br /> Storage Location_ (SAS,Ito Casing type Sck Iko PO <br /> _... Blank ft. Screen 5V- f o ft. <br /> Slot sizeQ.o j-b l/ <br /> GROUTING Bags cement <br /> •�- 9 S Buckets bentonite <br /> Depth to water_ Bags sand/gravel <br /> Mix Ratios_fo Ca f("-'jg pci 'Y Filter Pack type/size—:0--; <br /> Installation Mee od— ywi� Surge Block: - (�y/ n ) <br /> Quantity Installed Discussed with geologist: - n) <br /> EH 29 29 Type of method <br />