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MONITORING WFIL INSTULATION REPOT f <br /> Ly <br /> Date: C Z CONSTRUCTION <br /> Premise Address: Z�1S 1/- Total Depth �0 <br /> .�I Screen Length (from) 50 (to) <br /> Well No.: � �5 - _- Filter Pack (from) 150 '(to) 5, <br /> I Bentonite <br /> (to)Bentonite (from) (to) 3a4— <br /> Inspector: Grout (from) 36_ (to) O <br /> Drilling rig type 75 <br /> Pe l� it No.' Auger O.D. I.D. 4- <br /> Completion <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company:r T _ <br /> Driller: IWcf I- casing <br /> JI a height <br /> Consultant DTlY7Lli ___. <br /> j'�. i�GeLG <br /> Geo ogist <br /> ASONE-fGROUND ' (t: <br /> BOX <br /> 0OWFL.E ION ` <br /> SPECIAL PERMIT INFO. Ground 5urixt <br /> Di `{( S{�-_ <br /> Distance to sewer lineroot <br /> G_ i <br /> . Domestic well on site : (y - ` 30ft. <br /> s <br /> SAfL- <br /> MPLING — <br /> tisacian — C <br /> Holding Temperature IVIA — LravW pack <br /> Method lylf4 — <br /> Screening Method <br /> Tracking Sheet <br /> D,..,^� <br /> SPOY1ILS y R ' <br /> Storage Method s �L�-f'%d1 fX ;n MATER3ALS%REVELOPMENT µ <br /> Contamination Noted - (y� F <br /> Storage Location Casing type <br /> Blank; �' �j,`?N ft. -Screen � h• <br /> r Slot-size <br /> GROUTING Bags cement`' <br /> ``, Buckets bentonite <br /> Depth to to water T-� Bags sand gravel <br /> Mix Ratios Zg t- Filter Pack type/size - <br /> installation Method 30 641 Surge Block: = (.Y'CD 1 <br /> Quantity Installed 4 • Discussed with geologist:= (y, n <br /> Type of method 1 <br /> � . EHE 29 29 <br /> J <br />