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MONITORING WELL INSTALLATION REPORT <br /> Date: Zb C717 CONSTRUCTION <br /> Prer�tiwse` ddress: � [Zp- / S Total Depth 2,Z <br /> LL "e, }�"`e' ('`''a"`'`' _ Screen Length (from) ` (to) ZZ , <br /> Well No.:_ V\A M,(A) _AA L4) Filter Pack (from) (to)�_3� <br /> t - Bentonite (from) q (to) <br /> Inspector. a I.-• Grout (from) n -(to)-- <br /> Drilling <br /> to)—Drilling rig type <br /> Permit No. D a a s Auger O.D.- 2,'Z,t Y.D. <br /> Completion - Stove pipe iri�> (circle one) <br /> Drilling Company: <br /> Driller:_ rA\js _ T casing <br /> T he-ght <br /> Consultant X6& Ac, tArj= _per '4 <br /> Geologist_ C-_ <br /> , , ,.._ <br /> AZCVE-GacuND c rsry-aox <br /> CQh�F'l.�C 1`lON =MPL_mCN <br /> qVT <br /> SPECIAL PERMIT INFO. G=nd Su lwo <br /> Distance to sewer line 4+ <br /> Domestic well on site - (y/ n ) It` <br /> If yes, location and distance - �. <br /> v- o <br /> - w <br /> SAIIiPLING <br /> rior*d <br /> sa-Icn <br /> Holding Temperature <br /> Method____` brava!Facie <br /> Screening Method-- <br /> Tracking <br /> ethod —Tracking Sheet - n ) _r <br /> r — Z n. <br /> SPOILS <br /> I-Gn � trop <br /> Storage Method 4, MATERIALS EVEY.OPMENT <br /> Contamination Noted - KYR ) �^ Ul k 2"k <br /> Storage Location Casing type <br /> Blank fr- Screen__ 1 '_ ft. <br /> SIot size • 0 FO <br /> GROU'T'ING Bags cemenw 1• Sr <br /> Buckets bentonite <br /> Depth to water ti 49 . 5 —cl, Bags sand/gravel ti <br /> Mix Ratios ^' f Filter Pack type/si3112�ist. <br /> Installation Mctho Surge Block: - (yr�}Quantity Installed �/ it7 r� 46 [[��►.�� Discussed with ge - (y, <br /> Type of method <br /> EH 29 29 <br />