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MONITORING WELL INSTALLATION REPORT <br /> Date: 3 �� 160 CONSTRUCTION <br /> Premise Address: 1 :- -4%ey1..8 aw. Total Depth �s t <br /> Screen Length (from) 5 (m) 1.51 <br /> Well No.: YN LJ -o f4 Filter Pack (from) 3 ' (to) a, <br /> Bentonite (from) I th (to) -4 , <br /> Inspector. Grout (from) -C-7-- (to) 1 '/z, <br /> Drilling rig type <br /> Permit No, !� ©o`Z D I Auger O.D. I.D. <br /> Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company: �.� <br /> Driller: casing <br /> he±qht <br /> Consultant C-U�ontl—.D&� C4 4 <br /> Geologist S C4+4— t t�A ckl-- - <br /> ABOVE-GRCUND CtffMIM-80X ' <br /> COMPLETION COMPLEMN <br /> SPECIAL PERMIT INFO. Ground Stafaca <br /> Distance to sewer line K11grout <br /> Domestic well on site - ( r <br /> t �' ft. <br /> If yes, location and firs ante • t R <br /> m <br /> w <br /> = u <br /> C <br /> SAMPLING dorsi <br /> soden <br /> Holding Temperature d✓k I.CA = vd <br /> Method l , ()l,6,,. G <br /> ack <br /> Screening Method P 1 D <br /> Tracking Sheet n ) <br /> fL <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - 0/ n ) <br /> Storage Location c%, n i . Casing type 2 FV(L <br /> Slam[ ag S ft. Screen 2D_ft. <br /> Slot size 10-2-0 <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel 1 <br /> Mix Ratios Filter Pack type/size3 Sotnnr <br /> Installation Method Surge Block: - ( y/<A) <br /> Quantity Installed Discussed with geologist: - (y/©) <br /> Type of method <br /> EH 29 29 <br /> A <br />