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MONITORING WELL INSTALLATION REPOni <br /> Date: zoo CONSTRUCTION <br /> Premise Address: )�6E Total Depth <br /> 64Dfi+t /38Swc�/ Screen Length (from) LoY s (to) z <br /> Well No.: !(��/(� o kms Filter Pack (from) (to) '1 <br /> Bentonite (from) 57 /2- (to) <br /> Inspector: Grout (from) 53• (to) ' . <br /> �p Drilling rig type '90P IC- 4;rD 7� <br /> Permit No. ���b 3 Auger O.D. (0 I.D. 5 <br /> �� Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: /�Y <br /> Driller: <:2!�R— f y casing <br /> height <br /> Consultant <br /> Geologist <br /> ABOVE-GROUND CHRZ.D,�x <br /> CONFLETCN N <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line �-s6 grout •'' <br /> Domestic well on site - ( y j3 8� ft, <br /> If yes, location and distance - r S 2 ft- <br /> — m <br /> — m <br /> SAMPLING elonad = . <br /> e <br /> section <br /> Holding Temperature C Pavel pack <br /> Method _ <br /> Screening Method j = _ <br /> Tracking Sheet - (TFn ) 6q�/ <br /> 2 ft. ft. <br /> SPOILS (' <br /> Storage Method �l 9� d MATERIALS/DEVELOPMENT <br /> Contamination Note) Z a / /I� ��1 <br /> Storage Location Casing type �r,.4 'l <br /> Blank 34112— ft. Screen---LO—ft. <br /> Slot size •020" <br /> GROUTING Bags cement <br /> Buckets bentonite 1 (�30 <br /> Depth to war 0 Bags sand/gravel 300" <br /> Mix Ratios `[)« -Um A l/ f 3UCr Qo - Filter Pack type/size #3 <br /> Installation Method Surge Block: - (y <br /> Quantity Installed 5'5r55 Discussed with geologist: - (y <br /> Type of method <br /> EH 29 29 <br />