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,iwoNITORING WELL INSTALLATION REPO,,,,/ <br /> Date: B I l g Z CONSTRUCTION <br /> i <br /> Premise Address: 151-7n Q 14VQ-T_ &i G_ ADA-i, Total Depth / <br /> Screen Length (from) (to) 6 <br /> Well No.: W^ ZZ Filter Pack (from) _(to)� <br /> Bentonite (from) (to) 3 <br /> Inspector: �CJrfn_1 tzvo� � Grout (from) 3 (to) 4)_ <br /> Drilling rig type DAi4l►f'n__F_c .t..mT-P' U4- <br /> Permit No. q 2 Z U Auger O.D. I.D. 6.2 <br /> Completion S ove pipe/ lu-istie box (circle one) <br /> Drilling Company: Gbh <br /> i <br /> Driller: 3 casing <br /> height <br /> S <br /> Consultant (�(.C�2 � /3C,�f.Ib(ss5jC,1 <br /> -q <br /> Geologist /b&7-A T <br /> ABOVE-GROUND <br /> COMPLECfON CNASSTY-SOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Suiaca <br /> i <br /> Distance to sewer line ?ji'5D grout <br /> Domestic well on site - (y/6b <br /> 3 ti. <br /> If yes, location and distance - <br /> 4" m <br /> SAMPLING _= g <br /> socscn -" <br /> Holding Temperature 5' riM0L*JC, _ vzv'W <br /> Pack <br /> Method .' —_ <br /> Screening Method 'r _ <br /> Tracking Sheet - (y/ n ) <br /> SPOILS <br /> Storage Method 57- MATERIALS/DEVELOPMENT <br /> Contamination Noted - <br /> Storage Location Casing type .2 SCE- 4O ICG <br /> Blank ft. Screen ft. <br /> Slot size o/O <br /> GROUTING Bags cement 2 1 <br /> � Buckets bentonite <br /> Depth to water 4 Bags sand/gravel <br /> Mix Ratios /S0rivC 4*K lls,4 Filter Pack type/size <br /> Installation Method FgL_ Surge Block: - ((�)/ n ) <br /> Quantity Installed Discussed with geologist: - ((:p/ n ) <br /> Type of method �lEi rZs�1 <br /> EH 29 29 <br />