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ONITORING WELL INSTALLATION REPO* <br /> Date: 2 - Z Q 2 CONSTRUCTION <br /> Premise Address: 12 SC) ( LA�P Total Depth 2.5 <br /> Screen Length (from) 2:5' (to) ID . <br /> WellNo.: / Filter Pack (from) 25 (to) $ <br /> Bentonite (from) 8 (to)�— <br /> Inspector. S . 5CJA1J (l c7tSQ— Grout (from) to (to) 8 <br /> Drilling rig type <br /> Permit No. X12 " 3 2 Auger O.D. o. I.D. <br /> Completion - Stove pip c uistie box circle one) <br /> Drilling Company: <br /> Driller: WtLLa � casing <br /> height <br /> Consultant A UCS L%PrS Ck-" <br /> Geologist 1 F l lr 2✓C�l� - T <br /> ABOVE-GROUND C}4ilSTY 80X <br /> COMPLETION cOMPLETION <br /> SPECIAL PERMIT INFO. Grourd Surlaoa <br /> Distance to sewer line 7 of0� <br /> Domestic well on site - (y/ n) <br /> If yes, location and distance - ft. <br /> ft. <br /> ft. _ <br /> V m <br /> Y <br /> SAMPLING sloned <br /> 4 o G axion — <br /> Holding Temperature _ gn„ylPack <br /> Method I CCs 3 — <br /> Screening Method — <br /> Tracking Sheet - ©/ n ) '.Y __ . <br /> ft. <br /> SPOILS <br /> Storage Method 1� -DV-LLH e, MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n) t, <br /> Storage Location n� lsrnS7 Casing type 2 Gl� 40 P� <br /> Blank /0 ft. Screen <br /> Slot size 620 <br /> GROUTING Bags cement 3 <br /> t Buckets bentonite UN t _ <br /> Depth to water Bags sand/gravel ILritL <br /> Mix Ratios �_ l Filter Pack type/size 44 `5 <br /> Installation Method <Z?-a,- Surge Block: - ( y/9)) <br /> Quantity Installed, 1ss Discussed with geologist: - M/ n ) <br /> Type of method <br /> EH 29 29 <br />