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OMONITORING WELL INSTALLATION REI <br /> Date: I CONSTRUCTION <br /> Premise Address: WO Do✓HA.WLrr' Total Depth 22 <br /> �' { <br /> Screen Length (from) 2Z (to) <br /> Well No.: IV�w J� Filter Pack (from) 22 (to) [a <br /> Bentonite (from) to (to) <br /> Inspector: Grout (from)—(to)- <br /> Drilling <br /> from) (to)Drilling rig type <br /> Permit No. Auger O.D. ,t" I.D. <br /> D(N�ULAA Completion - Stove pipe/ rtstie box (circle one) <br /> Drilling Company: �J <br /> Driller: 4 VL casing <br /> height <br /> (Iepjnal /�Cj <br /> Consultant <br /> Geologist VV 1l tl Y IV It° �L) l <br /> ABOVE-GROUND CNA7STY BOX <br /> t�MPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground SuAan <br /> Distance to sewer line grout <br /> Domestic well on site - V n ) <br /> ft. <br /> If yes, location d distance - <br /> M,la � 60' <br /> r <br /> SAMPLING slatted = 8 <br /> section - — <br /> Holding Temperature oaL ' <br /> V&VW Pack <br /> Method (J� r-ktSd- W1 CYUShn vie <br /> Screening Method =_ <br /> Tracking Sheet - ( y/ n ) <br /> SPOILS <br /> Storage Method IMp At)w>-S MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( Y n ) 2 if p U c <br /> Storage Location Casing type <br /> Blank -4- ft. Screen 15 fr. <br /> Slot size . 07-0 <br /> GROUTING Bags cement Hila <br /> I Buckets bentonite <br /> Depth to water A- � ID �rBags sand/gravel MW - -4 5-4.5 <br /> Mix Ratios Filter Pack type/ ize 4;Installation Method Surge Block: -U/ n ) <br /> Quantity Installed Discussed with geologist: - n ) <br /> 1 n 1 yv Type of method ln�twlL _ GQQ dt 0 <br /> EH 2929 NDV-. KW boK /P3' a+V1 5vvjll?-) <br />