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NITORING WELL INSTALLATION REPO <br /> Date: o 3' I5-9'S CONSTRUCTION <br /> Premise Address: '3 bo c,-" C-OA2-16E2 uJA.t Total Depth <br /> Screen Length (from) 51.E (to) 3 b <br /> Well No.: M L'.) -z Filter Pack (from) (to) 2R <br /> Bentonite (from) 2.y (to) z.v <br /> Inspector: 2ou.3e Grout (from) V, (to) f A.%' _ <br /> Drilling rig type ( 4 <br /> Permit No. 605k-19i Auger O.D. (2 s/71 Zj <br /> Completion - Stove pipe/ istie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> ��,( height <br /> Consultant Cam <br /> Geologist <br /> ABOVE-GROUND CHRZTY-BOX <br /> COMPLETION COMPLETICN <br /> SPECIAL PERMIT INFO. ^d Saxe <br /> Distance to sewer line grart <br /> Domestic well on site - (y/ n ) Z ft. <br /> If yes, location and distance - <br /> m <br /> _ m <br /> O <br /> SAMPLING slotted <br /> sec on <br /> Holding Temperature prsvei pack <br /> Method1a 6' i1fCd�Ati7 r,ecT = <br /> Screening Method = <br /> Tracking Sheet - n ) <br /> SPOILS <br /> Storage Method jtlV �o bael MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( / n ) �,r (5 �� <br /> Storage Location ��5 l Casing type <br /> Blank qM 2)0 ft. Scre n 7,v ft. <br /> Slot size 0 •07,0 <br /> GROUTING Bags cement <br /> I Buckets bentonite 1 <br /> Depth to water • Bags sand/gravel L Ln tob q <br /> Mix Ratios Filter Pack type/ ize <br /> installation Method '\'\U\ Surge Block: / <br /> n ) <br /> Quantity Installed Discussed with ologist - / n ) <br /> Type of method. A„Zb1aL/ <br /> EH 29 29 <br />