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'VONITORING WELL INSTALLATION REPORT <br /> 41))01 <br /> Date: <br /> a1�nit��J <br /> Date: �26 // CONSTRUCTION <br /> Premise Address: Ma/°n Jfr'e j nl4nfAe�Total Depth_ <br /> , —Screen Length (from) �! ' to " (to) <br /> Well No.: .Sp 1 q a s Pro bc.s SG-12 411 ro va h S G Filter Pack (from) 5- 1 (to) /f ' <br /> / Bentonite (from) 5g ' (to) 2 <br /> Inspector: V;U' Mt4rl-n ez' Grout (from) .2 (to) ' <br /> Drilling rig type_ ha "j <br /> Permit No. .2. 3 2- Auger O.D. 3 z" I.D. U <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: FDII K/D r�;R and // /l S /6WDG� <br /> Driller: Jo L e T,'na /i1��Si.r Y�fi+ Jua.7 casing <br /> - 13, b ici•r1 height <br /> Consultant S*'d n�e�� T7 T <br /> Geologist Ce <br /> ABOVE-GROUND <br /> COMPLETION -80X <br /> COMPLETION <br /> SPECIAL PERMIT INFO. around Surface <br /> ��Q GS f SO�l��✓ ru bL /s Sv r�t*��-- <br /> Distance to sewer line /).b., �.2o '�u/Gy Cr out <br /> Domestic well on site - (y/49 ,� Z ft <br /> If yes, location and distance - ,ft. ft. <br /> L <br /> SAMPLING a i n�jj2/S <br /> slotted <br /> seclon <br /> Holding Temperatures r <br /> vel Pack <br /> Method <br /> Screening Method <br /> Tracking Sheet y n ) — <br /> /��/• IF <br /> ==4 I Fft. <br /> SPOILS <br /> Storage Method sf 4-G MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/0 <br /> Storage Location aCasing type 0 <br /> P (rU Blank 41' 8'I mfr Screen <br /> Slot size N )4- <br /> GROUTING Bags cement 125: r - 47-IbA ",rr/6n,-- <br /> Buckets bentonite I /z ! i <br /> Depth to water 0 t- -I—a Bags sand/gravelI Vz <br /> Mix Ratios n ki,tj1 1 )I per %8 b41 a� Filter Pack type/size /h�c ��- '2 S <br /> Installation Method c a(�v M 5- II t `�7-fib Qdi kr��Surge Block: - (y/ n ) �� 5 <br /> Bort I p nd <br /> Quantity Installed -1-0�' u t s I s o ,��s Discussed with geologist: - ( � ) AIA- <br /> Y-0 U+ Type of method <br /> EH 29 29 fib a ve, Me, e5Ct-22ry , `he'r2 Ljos s rIL-�pD-F a <br /> I -Ro o.t o h c��ra� ,(�,�►t�-dYi �`' ` tet i` e <br />