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&ONITORING WELL INSTALLATION REI <br /> / <br /> DU <br /> le-1 --114 S'e f <br /> �6� <br /> OV <br /> Date:___ 5��� �l]d 5"pA CONSTRUCTION <br /> �uTsreeil - <br /> Premise Address���37� s2r Total Depth 2S <br /> / 7 Screen Length (from) S (to) 2 <br /> Well No.: (O fit/ / ,4 ,S Filter Pack (from) (to) ZS�— <br /> / Bentonite (from) ' ' (to) <br /> Inspector: Gf -e� Grout (from) %t (to) 2/�— <br /> Q Drilling rig type i SA <br /> Permit No. S 1` O Auger O.D. /o'/ I.D. <br /> Drilling Company: L.=fell " <br /> � II 1 j� Completion - Stove pipe/christie box (circle one) <br /> GU!7 !� ��fw>/ <br /> Driller: Zd a !K ((elllrW// r/Ltl/ TT casing <br /> Consultant �i�wll J6w�7 height <br /> �4cJi �G <br /> Geologist ai lLtd1{, �G 1180VE tdROl1ND __ <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n) !v ` $r Sf <br /> 1 ft. <br /> If yes, location and distance - /I- 4P 5 ft. <br /> n. <br /> S? r. <br /> 2f <br /> MLS _ <br /> SAMPLING slotted = <br /> wcdon � — <br /> x: — <br /> Holding Temperature <br /> Method = f <br /> ack <br /> Screening Method r <br /> Tracking Sheet - (y/ n) : _ <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) <br /> Storage Location Casing type <br /> Blankr ft. Screen ft. <br /> Slot size • D�7� <br /> GROUTING Bags cement <br /> PU-pq Buckets bentonite toMef5 <br /> Depth to water Bags sand/gravel =j '3dAik kl✓I!'� <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 2929 6i�y¢✓i�Y�cG�j� l�vn�`�1ry ///90(/4,1Q – Z 9NY <br /> 2 ovi - 3crtui +i 1 o✓el' 5< 41qvSeeu7 <br /> C Z <br /> 9-2Z-09 �Gf/-"l -�f} <br />