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`.dONITORING WELL INSTALLATION REPC,icT <br /> c�i co c� M tt) — ✓n R 0 4-J _6 ,lW �rz�is cl A;_� <br /> Date: `I I�lry i� ( M CONSTRUCTION <br /> Premise Address:Lib Total Depth 5 <br /> G Screen Length (from) (to) 66 <br /> Well No.: Lo I Filter Pack (from) h (to) 6'4 <br /> Inspector. Bentonite (from) &'3 (to) <br /> � <br /> fy tCr a`1 Grout (from) (P/ (to) <br /> Drilling rig type 9- 1 <br /> Permit No. �� Auger O.D. 93/4 I.D. q,/-t <br /> /' Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company:_ Jl.C9�y� <br /> Driller: �r �o casing <br /> height <br /> Consulta„r _ 2 m <br /> —EWT <br /> Geologist � t�� '� <br /> ABOVE•GRCUND CHRi T 430X <br /> COMPLETION CHR <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line <br /> grout <br /> Domestic well on site - (y/ n) <br /> If yes, location and distance - <br /> E� ftft. <br /> SAMPLING Cwy (Arµ G /� `�' donai _ 'E <br /> C/ I/ <br /> soden <br /> Holding Temperature = SXavWG <br /> ack <br /> Method K <br /> Screening Method _ <br /> Tracking Sheet • (y/ n ) <br /> ft. <br /> SPOILS <br /> Storage Method ',ti✓ MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ r) li <br /> Storage Location d� Sf Casingtype )" P <br /> Blank 6 ft. Screen ZO ft. <br /> Slot size 02 ,0 <br /> GROUTING Bags cement <br /> Buckets bentonite / S <br /> Depth to water �- d Bags sand/gravel z <br /> Mix Ratios_r94t4alA Filter Pack type/size Z <br /> Installation Method -6� �- X-e cu < t Surge Block: - (y t <br /> Quantity Installed �'!Xt j X13 Discussed with geologist: - ((y)/ n ) <br /> Type of method <br /> EH 29 29 <br /> sea -8 <br /> � D �l . <br />