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IONITORING WELL INSTALLATION REPO <br /> Date: l I 115/0-01q <br /> CONSTRUCTION <br /> Premise Address:_ c(12- �KoN7A6o- RMAD,ppai) Total Depth_ Set <br /> Wel] No.: fX— 3 Screen Length (from) yo (to) SS' <br /> Filter Pack (from) -A ' (to) ass' <br /> Bentonite (from) -3�' (to) m' <br /> Inspector: 76lnrrd y6w<uw Grout (from) -j r" (to)o <br /> Permit No. Drilling rig type hk j10 ,, . Stu + q ry <br /> Auger O.D. I.D. <br /> Drilling Company: `�bre//Iho Completion - Stove pipe/christie box (circle one) <br /> r <br /> i <br /> Driller: VX-4 S41az� v casing <br /> L heigh <br /> Consultant �r. Is yint�vim (C�o�� <br /> J <br /> Geologist /Auc6s <br /> ABOVE-GROUND <br /> COMPLETION CHRz- -BOX <br /> SPECIAL PERMIT INFO. Ground COMPLETION <br /> �---�� Surlxe <br /> Distance to sewer line <br /> grout <br /> Domestic well on site - (y/n ) i <br /> If yes, location and distance - % ' ft. <br /> m <br /> SAMPLING <br /> Holding Temperature No r�awpley rc,Kee +mon <br /> Method _ pzvel pas <br /> Screening Method . <br /> Tracking Sheet - (y/n) ' <br /> Ss �- <br /> w� sem. <br /> n. — ft- <br /> SPOILS <br /> Storage Method Roil W bjH MATERIALS/DEVELOPMENT <br /> Contamination Noted - (67/n ) <br /> Storage Location &5s O- � &n�lbl;ry Casing type 56k 4o pUL , 6/f p,,, <br /> Blank_ 90 ft. Screen !S $. <br /> Slot size V.a 10 ; �1 <br /> GROUTING Bags cement q jR= 143 <br /> Buckets bentonite <br /> Depth to water $O Bags sand/gravel <br /> Mix Ratios ySo,,, D Filter Pack type/size <br /> Installation Method tr;ne,rtJ (x e d / o iow Surge Block: - (y/n) <br /> Quantity Installed 9fl 9 Ilows Discussed with geologist: - (y/n) <br /> EH 29 29 Type of method <br />