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,NITORING WELL INSTALLATION REPOI,, <br /> Date: bd I02 CONSTRUCTION <br /> Premise Address: 3D 3 ni G Yom, n f St', Total Depth 4 4e&� <br /> (to) -2& <br /> Screen Length (from) <br /> Well No.: M lAJ �p Filter Pack (from)—�—(to) 2-s-, <br /> / Bentonite (from) .25 (to) 2-3 <br /> ' <br /> Inspector. Grout (from) 2.3 (to)_ -S 0 r�6e Q <br /> �— Drilling rig type GM 1= IS- <br /> Permit No. d O S S s) Auger O.D. 9 i ri e-hef I.D. 4 . 2-5- i ael c S <br /> Completion - Stove pipe, _ tryst` e circle one) <br /> Drilling Company: 0-a s eCid e -Dr; li <br /> Driller: TD rcasing <br /> Asaistro{ T,�,, Z1c.4ar GJaL)a��,7homQS height <br /> Consultant Aalx/d,--d C� f;ny,fcrim afi`� <br /> Geologist E; 11 1-; ft I C. <br /> KaYLn e-4116Ja. COf�L`�ggpVUND <br /> J1 VLFCfbN <br /> Ma iGvae K )ew - tYQJ� c Gort7ro C.OMPLcTCN <br /> SPECIAL PERMIT INFO. ground Sulam <br /> Distance to sewer line ^ 4a gran <br /> Domestic well on site - ( y IQ) .23 ft. <br /> If yes, location and distance - 2 S ft- <br /> Pa r �:II L.tFJe �n�ru inLa,t� <br /> zeo <br /> 10"five <br /> :tefCf�•�� <br /> 1 F l J•ac I� — <br /> SAMPLING 50 : 1 Y[fmrles G°py)1 GrJ doral = <br /> ever $- `fC Pi1 �¢ D1 <br /> Q <br /> f D s°rcn <br /> Holding Temperature �t�Pack, <br /> Method iCe in o01 r Ie ' <br /> Screening Method <br /> Tracking Sheet - y n ) <br /> .75 <br /> u' <br /> SPOILS 3S- <br /> Storage <br /> SStorage Method_ .J S - d ll B YL).-ns V5, MATE RI ALS/DEVELOPMENT <br /> Contamination Noted - n ) <br /> Storage Location 0 n s, Casing type 4U <br /> Blank 2 G ft. Screen 20 ft. <br /> Slot size <br /> GROUTING Bags cement $ z47-Ib T z Zr-V-f, LS4� f� <br /> hy�raful Bu6iets bentonite U�� )—�r*f4nY( <br /> 30rr,��, <br /> Depth to water 1L ,ISS Bags sand/gravel l4 SO at Ct c- L j u'yst't <br /> Mix Ratios 3S q_/ �/ �� �f�o0417-)b Filter Pack type/size 3 <br /> Installadon Method IALI be��men1 Surge Block: - CYY n ) <br /> Quantity Installed I batt-[. Discussed with geologist: - Ey)/ n ) <br /> Type of method <br /> EH 29 29 <br />