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MONITORING WELL INSTALLATION REPO <br /> Date: gh 1q <br /> (qI CONSTRUCTION <br /> Premise Address: I I Q �ll,f'x�Lt� Total Depth qd• <br /> Screen Length (from) Y v (to) q0 <br /> Well No.: l,) ^Dls^ S Filter Pack (from)-(to) <br /> " Bentonite (from) (to) <br /> Inspector Grout (from) SSS (to) -�-- <br /> Permit No. <br /> GlI - 1'773 huge O.D.g rig type I.D. <br /> Completion - Stove pipe/cluisde box (circle one) 1 <br /> Drilling Company: <br /> Driller: 2 i}r <br /> height <br /> i <br /> Consultant <br /> Geologist -Y-qw Li/X1'0A'Y1 --> - <br /> ABOVE-GRCUND Ct1AtSiY BCX <br /> COMPt ETION CCMPLEnCN <br /> SPECIAL PERMIT INFO. Ground Sudan <br /> Distance to sewer line ptart <br /> Domestic well on site - (y ft. <br /> If yes, location and distance - �.ry` M <br /> aJ_It. _ <br /> - 0 <br /> V. <br /> SAMPLING slonad <br /> �U sacdcn <br /> Holding Temperature = P <br /> Method <br /> Screening Method <br /> Tracking Sheet - (Q n ) 3: <br /> tL <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - y n ) "cnJus 5u1)w t:tn ga <br /> Storage Location Casing type i '5: 4'O ij(— <br /> Blank -'1 U ft. Screen Z0 ft <br /> Slot size fD.O2f1-) <br /> GROUTING Bags cement <br /> Buckets bentonite / <br /> Depth to water Bags sand/gravel <br /> Mix Ratios'i Filter Pack type/size <br /> Installation Method 6 19 -M wl Uu - Surge Block: - (dq/ n) <br /> Quantity Installed Discussed with geologist: - ( n) <br /> Type of method r l6�^�✓61d� <br /> EH 29 29 <br /> Ar 76 <br />