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MONITORING WELL INSTALLATION REPOnf <br /> Date: //��6 �� //0///�(o CONSTRUCTION <br /> Premise Address: LQf/.ke(dr 6/JlCtt6 /O[ '- SWAI Total Depth <br /> /,,,/�/� Screen Length (from) (to) <br /> Well No.: ,/tiLT/7` Filter Pack (from) <br /> (to) <br /> Bentonite (from)�(to) <br /> Inspector: ut Grout (from) (to) O <br /> Permit No. SJQ0 �6 Drilling rig type (ISN!E <br /> _ �C Auger O.D.�'C'/S iN:� LD. <br /> Drilling pony: <br /> I - -�/"_ Completion - Stove pipe/christie box (circle one) <br /> Com G� <br /> Driller:_ casing <br /> Q� height <br /> Consultant -16� .WOE <br /> Geologist P.tiJ <br /> V ABOVE-GROUN <br /> CONFLETION 15 CtIRZTY-BOX <br /> CMPLETION <br /> SPECIAL PERMIT INFO. Ground suf <br /> 4017 T Aw- <br /> tC <br /> Distance to sewer line �67O 8314 grout 52 <br /> Domestic well on site - (y 4D �I ICDA 1 iq tt <br /> If yes, location and distance - L2� <br /> (09 n. <br /> ADD G <br /> SAMPLING <br /> 0 <br /> sIOISGE <br /> da n psecion <br /> Holding Temper e / (. IS — <br /> pack <br /> Method g BI <br /> Screening Method LAVA4 <br /> Tracking Sheet - n ) <br /> SPOILS _ / �Q <br /> Storage Method ✓J��( /X � MATERIALS/DEVELOPMENT <br /> Contamination Note n ) <br /> Storage LocationA1J/1t iQ.or�i s� Q Casing type J S Py <br /> Blank ft. Screen <br /> Slot size •O/0 <br /> GROUTING Bags cement YN9 X/ll RY 7X 32 glei CC <br /> Buckets bentonite IV <br /> Depth to water `yz '/ Bags sand/gravel <br /> Mix Ratios 1 "U �Ij� Filter Pack type/size Z IZ <br /> Installation Meth d d Surge Block: - (y n <br /> Quantity Installed Discussed with geo ogist: - (y <br /> EH 29 29 Type of method <br /> 9 Z P- cc OV Cm �l Z A <br />