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MONITORING WELL INSTALLATION REP(,-ww. <br /> Date: 3'.3 "�S CONSTRUCTION <br /> Premise Address: �00 S• Q1,u FV-6W 1 P- Total Depth 60 <br /> Screen Length (from) U Q (to) <br /> Well No.: MLtJ- Filter Pack (from)_ _(to) b <br /> Bentonite (from) _(to) 3') <br /> Inspector: 120 L.)e Grout (from) -?1'1 (to) '71 _ <br /> Drilling rig type GYIe -1S (jA <br /> Permit No. d() S333 Auger O.D. % 1/4 I.D. Z h <br /> Completion - Stove pip is ie (circle one) <br /> Drilling Company: M I'2.rtt_ b lfAL4_in <br /> Driller: `Zc"?, 5L e E casing <br /> height <br /> Consultant C �- <br /> Geologist R-ucaVlL-( /�LA-Kj •- T <br /> ABOVE-GROUND CHR STY43OX <br /> COMPLETION COMPL.ETICN <br /> SPECIAL PERMIT INFO. Ground Surf ac* <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) X2)_ft. <br /> If yes, location and distance - <br /> A,0 ft. <br /> o <br /> SAMPLING slotted = c <br /> sac5on = <br /> Holding Temperature 0 i = gr, Pack <br /> Method <br /> Screening Method <br /> Tracking Sheet _/0 <br /> n ) r� 11 <br /> SPOILS <br /> Storage Method �� li^�.���1>1Jy��1(-?Ia1XYA�D MATERIALS/DEVELOPMENT <br /> Contamination Noted " y n ) <br /> Storage Location h ►( S. Casing type <br /> hl�i Blank 4A,) ft. Screen 2 D ft. <br /> Slot size 0 •021) <br /> GROUTING I 51� ags cement <`.X�A <br /> // uckets ntonite <br /> '�� <br /> Depth to water `tel- B gs san gravel <br /> Mix Ratios 1� �`�1F' er Pack type/ izef <br /> Installation Method ck' 6� a�-S <br /> �^mm V f ge Block: `n ) <br /> Quantity Installed to <br /> Discussed with geologist: (( / n ) <br /> Type of method <br /> EH 29 29 <br />