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�_JNITORING WELL INSTALLATION REPO <br /> _ Pin. .. w ..w- e+++'+► ... — M1. . Y ' <br /> Date: D ' . ' q.! CONSTRUCTION <br /> _ � ... �'!ryyis'7U Total Depth <br /> Premise Address: Screen Length (from) 5 .(to) <br /> Filter Pack (from) <br /> Well No. -Y (to) <br /> Bentonite (from) . - _ <br /> Inspector: Grout (from) 3• (to)____ '-^ <br /> _ Drilling rig type -�a --- <br /> < <br /> Permit No. /�� 2� r Auger O.D. �. 2 2 <br /> Completion - Stove pi cluistie•box circle one) <br /> Drilling Company: - <br /> Driller: OfJC4 casing <br /> _. <br /> he i ght., ` <br /> Consultant t S <br /> --j <br /> T <br /> Geologist t&o U AVI LA <br /> { y CO LEMON CVf11f`nVI. <br /> i SPECIAL PERMIT INFO. r ` -r C3 co nd Suiac+ <br /> gfout <br /> Distance to sewer line N <br /> Domestic well on site - (y/0 <br /> If yes, location and distance - - <br /> f e..«.,.... <br /> SAMPLING • <br /> aoc;fcn <br /> Holding Temperateire ' _ " _ val p . <br /> Method_ crir C S <br /> Screening Method Ov fir- <br /> Tracking Sheet y n <br /> }L . <br /> ` SPOILS. . <br /> Storage MethodMATERIALS/DEVELOPMENT <br /> ` Contamination Noted - n ) G001-4 <br /> Storage Location QA/ �1 � _ w Casing type LCAA " r-1 C- <br /> Blank . 5 ft. Screen /5 ft. <br /> Slot size <br /> GROUTING Bags cement <br /> ` Buckets bentonite 3lz 'Ti S <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack-type/size 3 CCS tFam mel- <br /> installation Method qRX& Surge Block: -(Q/ ii ) <br /> Quantity Installed Discussed with geologist: - (An ) <br /> Type of method_i -Gt�L <br /> EH 29 29 w 1a <br />