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MONITORING WELL INSTALLATION REPO <br /> ,�r5vn �� � 4((00A Gz�� <br /> Date: /V os( rr tAw ; 2411 CONSTRUCTION <br /> r ' p <br /> Premise Address: si) r71Y�1�/ Total Depth J, <br /> l Screen Length (from) 27 (to) <br /> Well No.: INS -Z Filter Pack (from)_SEA'- (to) <br /> 1 / Bentonite (from) 2 3 (to) <br /> Inspector: V O Gk-r l,dhah�i�w Grout (from) !`�—(to) ` <br /> I— Drilling rig type am E <br /> Permit No. S k A d 0 G 375' Auger O.D. 0i"i" I.D. 2 <br /> 1 Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: WD EX,o)orak}tr,, 4,aellr P; jov vie& -81v-e�L„ auN--r <br /> Driller: rAf w���f v casing U <br /> 4 <br /> r:ologist <br /> nsultant SidE,N�E-. <br /> LLfrlv _ZYd)ioroAr -h;tLVECROUND <br /> is�p&vk`- 1Javi ' Tuiz a— Joe_7z)j7 -4a` co&F�r;oN �oi.+P�i�n�x <br /> SPECIAL PERMIT INFO. �p Q Ground S <br /> ''„4o -PeeJ grouturlxs <br /> UIP II <br /> Distance to sewer line - �h <br /> Domestic well on site - (y AD) )4 L—n, <br /> If yes, location and distance - t_Pp"✓ n <br /> ad, 3z.1 pp �n. <br /> SAMPLING $0 r _slotted = c <br /> 6 spa section <br /> Holding Temperature c� 3 p`'P i G N<, _ V'�Pack <br /> Method 2D- °/%� _ <br /> Screening Method <br /> Tracking Sheet - ( n) <br /> SPOILS / <br /> Storage Method SS'CQ//,nnG1 Yt/Ypy( MATERIALS/DEVELOPMENT <br /> Contamination Note <br /> Storage Location d-vr�S� �e Casing type �. �+P�. - <br /> Blank 2 y5 ft. Screen Z 8. <br /> Slot size 0' O 2 d° j:A <br /> GROUTING Bags cement_ bej J)1t 'e_*t <br /> }1-sjBuckets bentonite a <br /> Depth to water ^� ��� Bags se(nd/gravel <br /> MixRatios )*,6 Filter Pack typesize jr- <br /> Installation Metho V Oq Surge Block: - (y/ n <br /> Quantity Installed�,2 b � 1/� o ' WV 1- / Discussed with geologist: -a)n ) <br /> I/ Type of method <br /> EH 29 29 ��v s 5r2 may, kvh4Q- ( a be u f 6ul <br />