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t ¢`"7NITORING WELL INSTALLATION REPOT <br /> it <br /> Date: CONSTRUCTION <br /> Premise Address: 1� L �. Total'Depth" <br /> Scree a'Length.(from) (to) <br /> Well No.: '`(W Filterj'Pack I; (from) (to) Z <br /> BenA' ite . . ! (from) 2- (to)—A,39 <br /> Inspector: Grout '� (from} 3 (to) <br /> I <br /> Driili g ng type <br /> Permit No. Ir <br /> Augerl O.D. 1i ' Z I.D. <br /> ` t`n ' I �' <br /> Completion'!],Stove pipe/christie box (circle one) <br /> Drilling Company GGLe� c� K i <br /> Driller: <br /> - casing <br /> height <br /> Consultant ' <br /> � I <br /> Geologist _ .. AE;fh.GRQL1NO e /���� �y' �/�y <br /> A.`-Yom%h�h �IVN *� �'^-'� -�>t:.�,.. � � � CIHAL -acx <br /> COMP <br /> ,. G=nd Surface <br /> SPECIAL PERMIT INFO. <br /> ,Distance to sewer line proof <br /> Domestic well on site - (y/.n) z q <br /> if yes, location and distance 3 <br /> SAMPLING , �q; slotted <br /> n:- <br /> Holding Temperature - i.r_F. �� „ `' ' — ��pack <br /> Method <br /> Screening Method .4 <br /> Tracking Sheet - (Q/ n <br /> SPOILS <br /> Storage Method �'7 -ti MATERIALSDEELOFMENT ,` - �• <br /> Contamination Noted (y/ rf) i1' IF ` <br /> Storage Location =; 27>t A t- �}-�+��L�( Casingltype !�54i yU PUC y <br /> ` Blank__f-- 1/_5 ft. Screen 24 ft. <br /> Slot size 10 <br />` GROUTING 3 Bags cemenC& W - <br /> - Buckets-bentonite <br /> Depth to,water O i Bags sand/grave �aSr <br /> Mix Ratios '- �D' - Filter,Pack typee <br /> /siz <br /> Installation Method Surge dock, �j�/ n ) <br /> Quantity Installed !1[4�_ `'' , Discussed with geo gist: Q/ n )` <br /> { Type of`method f 4&, e-,e4 - <br /> ' Ivy 1 <br />