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- _ MONITORING WELL INSTALLATION REPORT <br /> 4 <br /> Date: 41 131. b V- + � ..� • <br /> CONSTRU=ON <br /> Premise Address:—'3?-J z N. ( �, �ar�?ilI_ oSjF. Total Depth e-elf, <br /> ^ Screen Length (from) <br /> Well No..-- �l _�---� i•r-SD4i R D� 1JGl �) Filter Lac <br /> ( }— -- <br /> .7 k (to) <br /> Inspector, • M e - Bentonite (from)�5-8 �f _(to) " <br /> Grout (from)_ <br /> Permi{No. k 003 !jS'"� ° .t '.Drilling rig type <br /> Augcr O.D. ,`' I.D. <br /> _ `Completion- Stove pipe/cluistie box (circle one) <br /> Drilling Company-- �+ _ A- �Yr <br /> Driller: -" eY <br /> �- �, casing <br /> Consultarl[Joe Velasco - Q S; '24 <br /> � -:F'he_ght <br /> 4 T r 1 <br /> Geologist Je f+ $Yp o k,S` - - <br /> VR5 }-�P�WL and Jf f¢� O{4t'cer -ra' ek 64 ion A OVE-6RCUND <br /> U2S Cons-�'ry ,rn Fore !1'�d cow�MON C GZ7Y-Box <br /> SPECIAL P£RMT INFO. h ~ �e'tiSore j fOS --�C� <br /> r/ C-cwrid Sulacs <br /> Distance to sewer line <br /> Domestic well on site - {y/ <br /> If yes, location and distance - � It• <br /> SAMPLING k. <br /> .., .,til alorA.i e <br /> Holding Temperature ° f • socicn - <br /> Method o r � r � gataiFaQc <br /> Screening Method _ }_ _— <br /> Tracking Sheet - nIt r <br /> ) — <br /> ft.. RM <br /> ft. <br /> SPOILS ' <br /> Storage Method C o Ve reel ) I4 n ed bin MATERIALS/DcVEE.OPMENT <br /> Contamination Noted - ( /n ) <br /> Storage Location n Z2 S;+e Casing type uG k 2 r' ch <br /> Blank f[- Screen5 fr. <br /> Slot size <br /> GROUPING : Bags cement <br /> f Buckets bentonite I YO M 19aig H.,It JOUBch: s <br /> Depth to water �o T SO p -. Bags sand/graveI -1 b0 son <br /> Inst Ratios r �1"- 5 ,a 4 1IMS Filter Pack type/size <br /> istallation Method Surge Block: - (y/ <br /> Quantity Installed 1 6. o� Discussed with geologist:EH 29 29. :�/ n) <br /> Type of method ,1 g <br /> rl P- 41D <br /> 5 <br />