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MONITORING WELL INSTALLATION REPOT <br /> � tfic <br /> Date: 13 g <br /> CONSTRUCTION � <br /> �t 7v� �G�C �. Total Dc MW' <br /> Premise Address: Depth <br /> P <br /> Screen Length (from) �70 (to) 5 S <br /> Well No.: gJ-�CJ / M W �D Filter Pack (from) (to) <br /> M, n ` / Bentonite (from) of (to) 4 <br /> Inspector: 1 t t �Y S Grout (from) 45 z�(So) <br /> p �j Drilling rig type Mob 12 l <br /> Permit No. 12 a��0 3 Auger O.D. I.D. Y `� <br /> j2 5 k— C Completion - Stove pipe/ ' e o ircle one) <br /> Drilling Company: W <br /> Ion �aranq,00 - dr lIC <br /> Driller: Miu k 0 o I n 171— <br /> casing <br /> conn rt�! - !n¢lptr^ ♦ height <br /> Consultant ZE5NAGeologist TDrv1 L iJ�Ct�YYI� <br /> ABOVE-GROUND C14 M43OX <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground S <br /> ` <br /> Distance to sewer line <br /> �S D SP eV`'TJ grout <br /> Domestic well on site - (y/ n 45. <br /> �ft, <br /> If yes, location and distancet) eJa 8 it. <br /> R. <br /> O <br /> SAMPLING dorsi <br /> on <br /> sori <br /> Holding Temperature G�CJ o = pawl Past <br /> Method blue (c-Q c r L)S Kad <br /> Screening Method DJ i" <br /> Tracking Sheet - (y/ n ) <br /> ft. <br /> SPOILS I <br /> Storage Method_1t<<G'rp �l n MATERIALS/DEVELOPMENT <br /> ContaminationNoted - (y/ n Z �Vi✓ 5�4� <br /> Storage Location i — Casing type <br /> Blank 5 h. Screen Z.0 ft. <br /> Slot size . CIO <br /> GROUTING Bags cement <br /> 55 Z Buckets bentonitL)C <br /> Depth to water Bags sand/gravel 'Pj5 <br /> Mix Ratios Filter Pack type/size Ic C Wend Ir r <br /> Installation Method -i'hv-c)4 r5 Surge Block: - (y/LT <br /> Quantity Installed ;�D Discussed with geologist - y' n ) <br /> O 9 Type of method <br /> EH 29 29 <br /> yzo 65 rtiQs (05'ed <br /> Ce�i- ��✓ �Ixi�S C,��,Q � (pr,�J� �3 N . <br /> V � �5 <br />