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.NITORING WELL INSTALLATION REPOI.— <br /> Date: 17 -68 CONSTRUCTION / 1 <br /> Premise Address: en r> e Total Depth <br /> Screen Length (from) 4 (to) 2L <br /> Well No.: M W - s Filter Pack (from)— i —(to) 25-- <br /> n� Bentonite (from) 025 (to) 23 <br /> Inspector. n I!6ri-n+e9 Grout (from) 23 (to) Surface <br /> Drilling rig type Ll mlt c fL <br /> Permit No. r,65* 3 F3 Auger O.D. 7 n et I.D. 4. 2S Vn&h e r <br /> Completion - Stove pipe mnsne o (circle one) <br /> Drilling Company: e12 Seta e Dn 2J <br /> Driller: Ja 4 De-_g_n. casing <br /> Asstst� f� rigs, I�rnerlcat�a J7?gnn � height <br /> Consultant ��van � j aY , (3C-E 4n <br /> �r7Vlronrn m (6FGE� <br /> Geologist 73i 11 L j4: I - (f O <br /> ABOVE-GROUND <br /> COF.fPLET1ON CCMPLEnCN <br /> SPECIAL PERMIT MO. Six* <br /> ti prcut <br /> Distance to sewer line <br /> Domestic well on site - ( y A�D _ft <br /> If yes, location and distance - ft. <br /> = m <br /> _= c <br /> SAMPLING <br /> d S4n2Qp�CJL!/�eGOL��eLT�d to-c:cn _ <br /> Holding Temperature N f} = gavel PaCK <br /> Method N� <br /> Screening Method X n <br /> Tracking Sheet - ( y/ n ) N #J- <br /> SPOILS <br /> Storage Method - e MATERIALS/DEVELOPMENT <br /> Contamination Noted -(Cyn ) W4�k <br /> Storage Location iJri rr S o q le Y Casing type 2 srh edv)e 40 <br /> Blank 21- ft. Screen 2 0 ft. <br /> Slot size 0. 0 2-6 <br /> GROUTING Bags cement I <br /> Buckets bentonite I - _ / q - <br /> Depth to water ^- 32 feel Bags sand/gravel 1 8 50--11 bass C6m ,X ofrc <br /> Mix Ratios ti 3 0 LIdi l o o s ofy is�`� l a 47 )b b Filter Pack type/size df 3 <br /> Installadon Method I/ Surge Block: - ( y r14 �t <br /> Quantity Installed I b a f�.l` Discussed with gec ogist:. - ( y'�1 <br /> Type of method <br /> EH 29 29 <br />