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ONITORING WELL INSTALLATION REPO <br /> Date: �J 3 ��IICONSTRUCTION <br /> Premise Address: 47d7 -OXAL Total Depth (o <br /> Screen Length (from) (to) <br /> Well No.: /IW Filter Pack (from) _(to) 4 <br /> Bentonite (from) (to)� <br /> Inspector: �3- Gf'rb k iNFP� Grout (from) 44.:5' (to) B <br /> Drilling rig type a - <br /> Permit No. Auger O.D. 0.2 I.D. 2 <br /> Completion - Stove pip cPu de box (circle one) <br /> Drilling Company: LJODI�(�A`/U� .cYLlCt i n� <br /> Driller: L7ZLC , �� casing height <br /> Consultant /�sSnP/} '4 <br /> _EWT <br /> Geologist �IC i� lu ourAj •- <br /> ASCVE-GACUND CMAISTY80X <br /> CCA4°LE�ION CCMPIH w <br /> SPECIAL PERMIT INFO. Ground Surlaa <br /> Distance to sewer line L 6D grout <br /> Domestic well on site - (y/(g) Ft24xu Go"o-oY qw-a xj ft. <br /> If yes, location and distance - 1E)Xle: Il <br /> ft. _ <br /> ^A m <br /> SAMPLING alonad = 'E <br /> a�cn %• __ <br /> Holding Temperature 4eG = �� <br /> Method r2aw� la <br /> Pack <br /> Screening Method PT D <br /> Tracking Sheet - (Ly,/ n ) <br /> 1t. <br /> SPOILS <br /> Storage Method ,'v MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location On( .' ,ty - Casing type <br /> Blank 7' fr. Screen Zo ft. <br /> Slot size D. 01 b <br /> GROUTING Bags cement LuCcd <br /> Buckets bentonite <br /> Depth to water zss Bags sand/gravel <br /> Mix Ratios Ix fur: Filter Pack type/size_ a Z <br /> Installation Method LtcSurge Block: • (6-)111 ) <br /> Quantity installed I;IL; Discussed with geologist: - (m/ n) <br /> Type of method '/Nutt Mawu qsr� <br /> EH 29 29 <br />