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ONITORING WELL INSTALLATION REP* 2 <br /> K 0 <br /> Date: 12 V I d Z CONSTRUCTION <br /> ,�'�L/ I <br /> Premise Address: 41x:1 11Ce_ Total Depth :H,2 . CJ <br /> Well No.: ?),I g I Ix 'Zr' Screen Length (from):-'. (to) 52•S <br /> ' 1 W I Filter Pack (from) 'T Z•ri (to) 5-D <br /> Bentonite (from) O (to) <br /> Inspector M Vti1��s Grout (from) (to) 44'• <br /> Drilling rig type <br /> Permit No. QZ~ Z� SZ Auger O.D. I L° <br /> Drilling Company: <br /> W es��� Completion - Stove pipe/ sne bo (circle one) <br /> -Pony -34rram'd1D -- dr,lle✓ <br /> Driller: M rl.% VL-xKre� – 1121 ✓ � height casing <br /> Consultant �Resmiy —QVT <br /> Geologist ,I o Wl Lu W4'i' a Pi - <br /> ABOVE-GRCQN0 CHMM-BOX <br /> CON PLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground SuAx� <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ ft. <br /> If yes, location and distance - 5� 5R SD h, <br /> O <br /> SAMPLING dotal = <br /> oo <br /> Holding Te AAerature 21k, 0gnvd <br /> MethodPack <br /> t 'a __ <br /> >: <br /> Screening Method —_ <br /> Tracking Sheet - (y/ n ) ; <br /> rt. <br /> SPOILS J t d! q <br /> Storage Method L11GLV� �(n � 3� MATERIALS/DEVELOPMENT <br /> Contamination Noted . y h ) /1 PUG <br /> Storage Location Casing type <br /> Blank 525 ft. Screen <br /> Slot size Glfl <br /> GROUTING Bagscement tel. <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method t� Surge Block: - (y'V <br /> Quantity installed 1f;0 c Q Discussed with geologist - y n ) <br /> �') (`, <br /> Type of method <br /> EH 29 2 ? <br /> ,: a� <br /> 6WCO <br />