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*ONITORING WELL INSTALLATION REPO <br /> Date: Wa✓ern bar Z, .20)1 CONSTRUCTION <br /> Premise Address: A� 1 Total Depth ,Y/ r J <br /> QG <br /> �J Screen Length (from) 4P (to) 39 <br /> Well No.: A S - t Filter Pack (from) Vl (to) 3 7 <br /> / Bentonite (from) (to)-�,�_ . <br /> Inspector: V )c�G� 1 Grout (from)_ 3 (to) 60YF�p <br /> Drilling rig type <br /> Permit No. 5Rik Oblo3ls-d Auger O.D. I.D. � eA <br /> L �BIIS Completion- S ove c 'stie box cle one) <br /> Drilling Company: Wj) 0, x4nra�-s an �- y,� 47 ✓a � '// s< <br /> Driller: casing 7 - <br /> JQ vi er JZ i z -+- Ja e. I?Okelr� s height <br /> Consultant v IF7LT <br /> dnf-- <br /> 9 0 C:m <br /> Geologist Z'r&Y 62 a kU a- ryqq qq ✓ ABOVE GROUND <br /> f�� c1J COMPLETION CNAISTY <br /> COMPLETIOMNN <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line ''v r P I grout <br /> Domestic well on site - (y n <br /> If yes, location and distance - R r 3 n. <br /> P <br /> 71. 1 <br /> SAMPLING 21- - /07. Ze( slatted = 8 <br /> ¢0 1 30 --1) 081p sac�an < __ <br /> Holding Temperature <br /> Method t T <br /> Screening Method P I D <br /> Tracking Sheet - y n) ,411 <br /> tt, tt. <br /> SPOILS J <br /> Storage Method S �Gf��(/w Gf r✓rr�J MATERIALS/DEVELOPMENT <br /> Contamination Noted - n ) <br /> Storage Location 0 rts -f Casing type <br /> Blank 3 9 ft. Screen Z fr. <br /> .--�t Slot size <br /> 9 ba- <br /> GROUTING <br /> N 1 Bags cement a/ 7-1 <br /> / t v Cr <br /> D+ ba,+#"rr+if'a • Buckets bentonite . <br /> Depth to water / 19,.�I Bags sand/gravel a,,)— - e <br /> Mix Ratios - 30-q//ry r off-`ulq{gr�6 7 ek waw Filter Pack type/size 3 ti <br /> Installation Method lirarll'r/� . rrs9sl`S, � �4//�dw r+* Surge Block: - (yn <br /> Quantity Installed 3 bQtMAJ V I Discussed with geologistyI: - n ) <br /> Type of method <br /> EH 29 29 � <br />