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C.10NITORING WELL INSTALLATION REPC`) - <br /> e . <br /> Date: ` L°l CONSTRUCTION <br /> j Premise Address:. j'-'Z'DS- f'r,�-�4 �w Total Depth <br /> 4 Screen Length (from) 5-.5 ' (to)_ as ' <br /> i Well No.: W n1 Filter Pack (from) 4;_� ` (to) <br /> —� Bentonite (from)_; 1 (to) s� <br /> Inspector: Grout (from) -a (to) <br /> I - Drilling rig type <br /> Permit No. D O l., Auger O.D. �.z ` _ _ I.D. <br /> j Completion - Stove pipe/christie box (circle one) <br /> Drilling Company:,�_/k b-D j n r l�u z-, , <br /> 1 Driller:��,rAA,\ /t-��n/AA/ -/t r~' _-- casing <br /> height <br /> T . <br /> Consultant Z _V1 <br /> Geologist _ ABOVE-GROUND o <br /> COMPLE PION CiiRfST Y-SOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. - Ground Sacs <br /> y <br /> Distance to sewer line -- grout <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - <br /> eft. <br /> O <br /> I � <br /> C <br /> SAMPLING slotted _ <br /> saclQn <br /> Holding Temperature 6y\ t t µ- - — <br /> I gMVVI paCSC <br /> Method��' _— ' <br /> C1 Fi�N> y Det 1A, <br /> Screening Method — <br /> Tracking Sheet - n) <br /> SPOILS <br /> Storage Method. Inti - MATERIALS/DEVELOPMENT <br /> Contamination Noted - <br /> Storage Location - Casing type '2. PNI L <br /> ' Blank S- ft. Screen. ._ . Za' ft. <br /> W- Slot size ►o�Q <br /> GROUPING Bags cement t C7 <br /> n - Buckets bentonite l - <br /> Depth to water I Bags sand/gravel <br /> Mix Ratios t Filter Pack typesize_ # , lcjti•.,:5 sa,. y <br /> Installation Method n,v�nn.l�L.�( _ _' Surge Block: .. (y n) <br /> Quantity Installed n-> 'i('l'• Discussed with geologist: -.�y n ) <br /> Type of method_ 1g2&_ <br /> EH 29 29 <br /> i <br />