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,.we MONITORING WELL INSTALLATION REkwwtT <br /> Date: 1 (Q1'�`o CONSTRUCTION <br /> Premise Address: -)V) L'LEA:� Total Depth 21 <br /> Screen Length (from) (to) <br /> Well No.: MW - I Filter Pack (from) 72 (to) _ <br /> Bentonite (from) Jto) <br /> Inspector: 1 b"j Grout (from) (to) <br /> Drilling rig type <br /> Permit No. D()tPq-+Z Auger O.D. I.D. <br /> Completion - Stove pipe isUe bo (circle one) <br /> Drilling Company: S?aA-WYV� <br /> Driller: casing <br /> 1. 1 17 T height <br /> Consultan ! W 1 I —q- M —qWT <br /> Geologist ABOVE-GROUND <br /> COMPLETION CtiRISiY-80X <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surfx* <br /> Distance to sewer line gr <br /> out <br /> Domestic well on site - (0/(OUA �d --n. <br /> If yes, location and distance - <br /> lie V�� of PYlnl s I-b . <br /> 4 = � <br /> ID <br /> b <br /> C <br /> SAMPLING slotted <br /> 'r G section <br /> Holding Temperature grx�*I pack <br /> Method <br /> Screening Method a • <br /> Tracking Sheet - ( n ) <br /> — ft. <br /> SPOILS <br /> Storage MethodCo�� MATERIALS/DEVELOPMENT <br /> 1.111P3111 V% <br /> Contamination Noted - ( n ) I <br /> Storage LocatioCasing type C <br /> Blank ft. creep la ft. <br /> Slot size D.cell) <br /> GROUTING Bags cement <br /> Bucke entonite <br /> Depth to water Bagsn gravel <br /> Mix Ratios Filter ack type/size <br /> Installation Method Surge Block: - (y/ <br /> Quantity Installed Discussed with geologist: - t( / n) <br /> Type of method (D;'"f <br /> EH 29 29 <br />