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&ONITORING WELL INSTALLATION REP ' <br /> Date: (n -3Lo- `lfI (-5� �h ` J CONSTRUCTION <br /> Premise Address: /(n oo A. .Z,, Total Depth 3 7 35 CS 1 o f > <br /> p Screen Length (from) 3S ' (to) 3,) <br /> re �Q vu / <br /> Well No.: mL ' !OS /� J/-� f � � Filter Pack (from) 3S ' ([o) <br /> Bentonite <br /> (from) 30 V'— (to) .qs- /a-- <br /> Inspector: Grout (from) (to) Qv <br /> Drilling rig type_ Lc en->O s � — <br /> Permit No. ni c, 0 7 4K Auger O.D. k//a" I.D. �/%v " <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: V 4- <br /> Driller: Lamy D'&I'le casing <br /> height <br /> Consultant_ <br /> Geologist_ <br /> ABOVE•GRCUND <br /> COMPLETION CHRISTY-BOX <br /> COMPLETIO <br /> SPECIAL PERMIT INFO. Ground Sudan <br /> 3' ce- grout <br /> Distance to sewer line _ tei r�/ o <br /> Domestic well on site - (y/ n ) t�a ft. <br /> If yes, location and distance - <br /> — a <br /> m <br /> d <br /> c <br /> SAMPLING <br /> 5bttnd c <br /> wc4an = <br /> Holding Temperature <br /> Method = gravWpack <br /> Screening Method <br /> Tracking Sheet • (y/ n ) {F <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type ®V c- <br /> Blank 3S '/eft. Screen a ' ft. <br /> Slot size b� <br /> GROUTING Bags cement <br /> Buckets bentonite / <br /> Depth to water S/7 Bags sand/gravel <br /> Mix Ratios Filter Pack type/size R <br /> Installation Method f w:,f Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n) <br /> Type of method `_ G ru ? 4Ke e <br /> EH 29 29C(o cJ J u:..r /U = 9 <br /> (i�U,u" <br /> l�' — /71 !PI <br />