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'-!rAONITORING WELL INSTALLATION REPOnI <br /> Date: �6 1yeb f ����� 6 CONSTRUCTION <br /> Premise Address: d 3 G� Total Depth � v r e tC� �CCl� <br /> Screen Length (from) go (to) <br /> Well No.: 2Ci Filter Pack (from) (off- (to)�_ <br /> Bentonite (from)�(to) G � <br /> Inspector: Grout (from) (to) O <br /> ry� Drilling rig type 95 CE- <br /> Permit No. a�4/7�jpb Auger O.D.046, /5" &?e'c I.D. V$^C,-- *ft' <br /> Drilling CoJ r^ Completion - Stove pipe/christie box (circle one) <br /> mpany: G�.GrX <br /> Driller: �ie '-:rot <br /> ✓e -� D casing <br /> �L height <br /> Consultant <br /> Geologist T <br /> ABOVE-GROUND� ' <br /> COMPLETION 7 COMPLETION <br /> SPECIAL PERMIT INFO. �/ 6rourd gW <br /> Distance to sewer line L dry° ` sg'roPof <br /> Domestic well on site - (ycn CG.Tpa(op' BENT <br /> If yes, location and distance - <br /> tt 67 n. <br /> Y <br /> h 0 <br /> tl <br /> - O <br /> C <br /> SAMPLINGs <br /> slotWd <br /> o /� sedon <br /> Holding Temper a l� <br /> Method _ gr'H°I Pack <br /> Screening Method M <br /> Tracking Sheet - 4V n ) <br /> SPOILS /�'� <br /> Storage Method 5 " Q�` WMATERIALS/DEVELOPMENT <br /> Contamination Not n ) <br /> Storage Location Casing type 2-1"-< <br /> Blank 70 ft. Screen (O ft. <br /> Slot size '0 ' 0 <br /> GROUTING Fouro04AW-cement 1D b Soo <br /> -� <br /> Buckets bentonite <br /> Depth to water L-- '- Bags sand/grave! <br /> Mix Ratios t y �.' Filter Pack type/size .2,112- <br /> Installation Me d Surge Block: - (y/ n® <br /> Quantity Installed7=12 Discussed with geologist: - (y O <br /> �S y "0"42"G jrType of method <br /> EH 29 29 '' �'fr;b <br />