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MONITORING WELL INSTALLATION REPOnf <br /> Dale:��� f <O/'0/-0 (W t CONSTRUCTION <br /> Premise Address: a! 3 (�OGI.�c-Lc� � rv� Total Depth <br /> ''`'/ Screen Len <br /> Well No.: i�2LT/ZB �Ly 7B Filter Pack(from) (t) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. �87`7Z'rOa �o Auger O.D. I.D. <br /> Drilling Company: Completion - Stove pipe/christie box (circle one) <br /> Driller: LC %?!t2 , I✓C' 'J•U <br /> casing <br /> <✓8L height <br /> Consultant Fl �j <br /> Geologist Tj <br /> ABOVE-GROUND CHRZ Y430 <br /> COhWPLETION <br /> N <br /> SPECIAL PERMIT INFO. Grourd 3urt <br /> Distance to sewer line >O 3 grout <br /> Domestic well on site - (y n <br /> If yes, location and distance - �/�, <br /> .Z(L.tt. - ft. <br /> SAMPLING <br /> slotted <br /> ye wc5on <br /> Holding Temper e _ ��P <br /> Method &�o�- <br /> Screening Method /i <br /> Tracking Sheet - y�]n ) <br /> 1�ft. ft. <br /> SPOILS ` - n �/kJ !61 <br /> Storage Method J5f%-(' / cMATER ALS EVELOPMENT <br /> Contamination Note n ) � LL '/ SGr� <br /> Storage Location o dv� d/ �Casing type 2''�I��(iXo�slP !D �C <br /> Blank D ft. Screen /a h. <br /> Slot size . 010 <br /> GROUTING Bags cement S -S$ 7 y.. ZSS05,e6 <br /> Buckets bentonite 3 <br /> Depth to water. 4 ia <br /> �_ �! � Bags sand/gravel <br /> Mix Ratios 4 tt 70 A T7P.tcl- Filter Pack type/size /Z <br /> Installation Methofl <br /> Surge Block: - n <br /> Quantity Installed Discussed with geologist: <br /> ist: - (y 0 <br /> Type of method <br /> EH 2929 de : 8/ � ab. P " �� 5716iec <br />