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0 0 <br /> MONITORING WELL INSTALLATION REPOnf <br /> Date: R' Z 3' /� p CONSTRUCTION. q <br /> Premise Address: Sl JO/Z.5 Jo/sd Total Depth —J7 <br /> Screen Length (from) Z (to) Z Z <br /> Well No.: � E l9 Filter Pack (from)—(to) 21- <br /> Bentonite <br /> 1Bentonite (from) 2z- (to) Zd <br /> Inspector: Grout (from) (to) O <br /> Drilling rig type - l <br /> Permit No. J�l�U Auger O.D. I.D. <br /> Drilling Company: <br /> Completion - Stove pipe Christie box (circle one) <br /> Driller: f�'� �` v`� casing <br /> (J height <br /> Consultant k7V <br /> T <br /> Geologist 6 4"�' - T <br /> 41 ABOVE-GROUND CHAISTY-BOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> 7 <br /> Distance to sewer line grout <br /> Domestic well on site - ( y� ?i0 ft <br /> If yes, location and distance - r/ Z ft <br /> O <br /> O <br /> C <br /> SAMPLING elarfad c <br /> a teCJon <br /> graw Pack <br /> Holding Tempey,�tt G <br /> Method C4 C = <br /> Screening Method O1l <br /> r <br /> Tracking Sheet -67 n ) N <br /> SPOILS K <br /> Storage Method 5S V� "� MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y Z,t /(� 1 ✓LI <br /> Storage Location 4&f- OV'LAy-�✓` y- Casing type <br /> Blank fr. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> _ Buckets bentonite " LakoLw <br /> Depth to water �"ZS Bags sand/gravel 15 <br /> Mix Ratios 'tt Filter Pack type/size 7 4 lb f /y <br /> Installation Method Surge Block: - (y 1 n <br /> Quantity Installed I Discussed with geo ogtst: - (y n <br /> Type of method <br /> EH 29 29 <br />