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I <br /> 410NITORING WELL INSTALLATION REPO KC <br /> Date: S' ' z)'D CONSTRUCTION q <br /> Premise Address: �k �il P n Total Depth Zy <br /> Screen Length (from) 110 (to) (OIJ <br /> Well No.: Filter Pack (from) 122 (to)_(Q'r_ <br /> / Bentonite (from) Ia$. (to)�_ <br /> Inspector. _ jWf/ Grout (from) 4S (to) <br /> Drilling rig type <br /> Permit No. 2 '' 3 Z Auger O.D. r.' I.D. <br /> Drilling Company: <br /> Completion Stove pi <br /> - pe/christie box (circle one) <br /> �--tS__�111n1 <br /> Driller: �RN �F � height <br /> casing <br /> Consultant Srn.A'N"/ <br /> Geologist I �i4>r�i� �/ T <br /> ABOVE-GROUND 0.4 t TY-aCX <br /> COMPLETION CCMPLEMCN <br /> SPECIAL PERMIT INFO. ®Ground S�"y <br /> Distance to sewer line Grout I <br /> Domestic well on site - (y/ n) q5 ft. <br /> If yes, location and distance - n, <br /> ' �ft. <br /> �� rO <br /> C <br /> O <br /> SAMPLING .longi <br /> p soc'cn <br /> Holding Temperature praval Pack <br /> Method <br /> Screening Method = <br /> Tracking Sheet - n ) 1 , Z. <br /> M <br /> cw LI�1/ � <br /> SPOILS t IIS -,W D t6S' b� Ie"Le.-.0 <br /> * <br /> Storage Method 111d•41%, IIV MATERIALS/DEVELOPMENT <br /> Contamination Note( n ) r <br /> Storage Location 1 Casing type " trAA Ab uL Zf <br /> Blank ft. Screen 1 fr. <br /> Slot size C) -n 2,0 <br /> GROUTING 1 Bags cement <br /> •1 1 Buckets bentonite <br /> Depth to water U^ v b � Bags sand/gravel <br /> Mix Ratios 1• Filter Pack type/ rze <br /> Installation Method Surge Block: • VY/ 11 )—T <br /> Quantity Installed Discussed with geolo ist. - (�/ n ) <br /> Type of method Ute, _ <br /> EH 29 29 <br />