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. .JNITORING WELL INSTALLATION REPO, <br /> Date: � �3 ! CONSTRUCTION <br /> Premise Address: ldl t5 • CTotal Depth �$ <br /> Screen Length (from) 17 (to) <br /> Well No.: Filter Pack (from) 61 (to) <br /> Bentonite (from) 4 ?S (to) <br /> Inspector: S • S 14 )u"60� Grout (from) g-0 (to) 4;=0 <br /> Drilling rig type O+0-Ct� <br /> Permit No. R l — Auger O.D. a - T <br /> n Completion . Stove pipTT <br /> tie box ircle one) <br /> Drilling Company: /'/C�Sl !'.J�,av� ��lLLtkLi <br /> Driller: KU (W i casing <br /> nheight <br /> Consultant ( ��/ / , Clb?l!-Yz �� C <br /> Geologist 066 dt-AwJ <br /> ABOVE=GRCIJND CiiRI5TY BUX <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> i <br /> Distance to sewer line 3W grout <br /> Domestic well on site - ( y / (j) ft. <br /> If yes, location and distance - r/� ft. <br /> N R. <br /> = c <br /> SAMPLING �icttod = e <br /> aacicn <br /> Holding Temperature <br /> Method 0hA ^ = <br /> Screening Method »> <br /> Z. _ . . <br /> Tracking Sheet • ( y / n ) <br /> ft. = % <br /> SPOILS <br /> Storage Method MATERIALS/DEVEI.OPMENT <br /> Contamination Noted - ( y/1 n <br /> Storage Location (OU SI Casing type El 40 wtw <br /> Blank ft. Screen ft, <br /> Slot size <br /> GROUTING Bags cement - - — <br /> i Buckets bentonite l <br /> Depth to water Bags sand/gravel <br /> Mix Ratios 54 _ Filter Pack type/size <br /> Installation Method �j2L, " m[7 / Surge Block: - ( y 1 <br /> Quantity Installed Discussed with geologist: - ( y / n <br /> Type of method <br /> EH 29 29 / _ � <br /> f(SCi 4a) 0eu1Ef Lf t ` 6RY� w �vu� 66vuoC115r. <br />