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MONITORING WELL INSTALLATION REPORT <br /> Date: 1 CONSTRUCTION <br /> Premise Address:'25�O C" '1r'V1 'Z"'+-i"14-Total Depth T�4�- tJC 7 <br /> Screen Length (from) (to) <br /> Well No.:12 M L, '— Filter Pack (from) ' 1 _(to) • ya <br /> Bentonite (from) (to)_�-3 ( d� <br /> Inspector: +� (QCs Grout (from)5k,...,r-(r..c_a_(to) <br /> I Drilling rig type M QK 1., <br /> Permit No. 69075 Auger O.D. (G" I.D. <br /> Completion- Stove pipe/christie box (circle one) <br /> Drilling Coohmppany: WE►1. "fes1A I -= 4� k�-' <br /> Driller: L' casing <br /> height <br /> Consultant <br /> Geologist—�r <br /> • VE-GR <br /> OOMPL.Ef CNA I5TY$OX <br /> COMPLEnoN <br /> SPECIAL PERMIT INFO. Ground Su face <br /> Distance to sewer line Grout <br /> Domestic well on site - (y/n) •j► ft. <br /> If yes, location and distance- ft. <br /> SAMPLING — nJpNG $Ion" Y: <br /> • aac9on �; _ <br /> Holding Temperature — 9n„E9 pack <br /> Method ' <br /> Screening Method _ <br /> Tracking Sheet - (y/nIF E-I) <br /> {{• K Il. <br /> SPOILS <br /> Storage Method�r�a�d o l 3 i�C_ �c�r ��; a i ��`16 MATERIALS/DEVELOPMENT <br /> Contamination Noted -0/n) ~�� <br /> Storage Location On '--f-.Al _ Casing type—JLA-tZ I' 1 'C-- y <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> B ckets bentonitea-ell i x F7 �v�r tac) <br /> Depthtowater -17ft Bags and/gravels <br /> arc;)-►Mix Ratios -5U � Jcj� Filter ck type/size r 3 <br /> Installation Method - Surge BI o : - (y/n) <br /> Quantity Installed �'' �_ Discussed with geologist: FYI/ n) <br /> wgo..C'a- o Type of method <br /> EH 29 29 <br />