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.ONITORING WELL INSTALLATION REPO. .. <br /> -sv n nco <br /> — �oV4-8p o <br /> Date : S - 7l2- i Z CONSTRUCTION <br /> Premise Address:_ Total Depth <br /> Well No. : fa S — Screen Length (from) �< (to) 2 3 <br /> Filter Pack (from)_ �2 (— (to) <br /> VI YIC � r Bentonite (from) 2 ) (to) I S <br /> Inspector: LA Grout (from) ) (to) 5:ar *4ee <br /> 7S-Drilling rig type P. inr <br /> Auger O .D. �_4 j>J1 LD. Zl!' <br /> Completion - Stove pipe/c istie bo ircle one <br /> Drilling Company: &Z �ai/ ��jg s yh <br /> Driller:_ )W d vat z G rJ0 r Z ; n f4';,�Z TT casing <br /> Ste. yjQ�,r height - <br /> Consultant � GF r <br /> Geologist <br /> ABOV€-GROUND <br /> COMPLETION WPCN <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line N f f) ! grout <br /> Domestic well on site - ( y / <br /> If yes, location and distance ! P tt• <br /> 423 tt <br /> — a <br /> ITT <br /> SAMPLING <br /> 0 <br /> dotted <br /> 1 tacJon — <br /> Hold ng Temperature_ - n d Sb lid/ Cy//Gd/� <br /> Method VA = <br /> Screening Method -=F _ <br /> Tracking Sheet - Cy / n ) 4t& _ <br /> 6 d w <br /> SPOILS <br /> Storage Method •J G7- l/ j-K, dYtI/f'[ S MATERIALS/DEVELOPMENT <br /> Contamination Noted - y n <br /> Storage Location_ _ cm , ri'ti Casing type �1 i n (+/�. Spiltca� SSD <br /> Blank 23 ft. Screen 2_, ft. <br /> Slot size ok 0l D ° <br /> GROUTING Bags cementA ..,)kl ejv 77�� x <br /> �' � Co &�. Buckets bentonite Ya 4 SO 1(0 6u � t <br /> Depth to water N ( �IS � ,yy � `� Bags sand/gravel � LaO:x 1 r}� / <br /> Mix Ratios �i 4 !b a® df4,h Filter Pack type/size 3 <br /> Installation Method rd4,p� 41A Surge Block: n ) <br /> Quantity Installed b&44 ^^ h 0 hu i� Discussed w geologist: - (ifs n ) <br /> Type of methody <br /> EH 29 29 <br />