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vow <br /> MONITORING WEI.i,IN <br /> STALL.ATiON REPORT <br /> Date: CONSTRUCTION <br /> Premise Address:_ ,7,2 0 4 W. J-J a yH n <br /> —LD h e— Total Depth ..F <br /> Well No.: 1)�S - 1 -}-h ro ,,, �, Screen Length (from) (to) Z7 feef- <br /> $- ID Oz9hs,o/sr� Filter Pack ([cora)��(Co) <br /> Inspector, y i C k i Me�Y}h �I Bentonite (from) {to) <br /> Grout (from) (to) ro v <br /> _ 1 4 <br /> Permit No. 8 .Dnliuz3 rigtype� � <br /> tco r' <br /> Auger O D. " � ( ^ �!4 R 1 L n�sie <br /> 4 <br /> g I�•__�.25 aecef,P <br /> Drilling Company: 111/ 'k tri III',, Co. Cornpletion - Stove pipe/chrisne box (circle one)--43 <br /> UJIq ',SILO�2� <br /> Driller: F ' r L�Jhi 1 <br /> 5 fey casing <br /> i»•t lA� 71 i 4rr+s SS,:rt�,zt)- he' ht <br /> COrfsllltdn[_ 5 .�.n� =g <br /> Geologist Yi Ce v <br /> A°OYE-GRCUND <br /> CHASN-30X <br /> SPECIAL PERMiT INFO. OD MP L.MO N <br /> C=nd Stsixt <br /> Distance to server line <br /> Domestic well on site - (y' n) oroc.t <br /> If yes, location and distance <br /> --_7 <br /> w <br /> SAMPLING - � <br /> I IO C.O,j y: C <br /> Holding Temperature socicn - 3 <br /> Method " <br /> 1' . cIwt Pack <br /> Screening Method D — <br /> Tracking Sheet / n ) — <br /> SPOILS 'ft. <br /> Storage Method_ /i Q rl Q f0� MATEPJALS/DEvE OP1V[ENT <br /> Contamination Noted - (©/n) - <br /> Storage Location Casing type C f B 0 <br /> Blank 2.7 ft. Screen 3 fr. <br /> GROUTING Slot size t <br /> r <br /> —`— Bags cement RMC lPeri I-a• <br /> Depth to water -}e — <br /> CE TCO-Buckets bentonite-) s Vy"Ce 1 49rt,, l <br /> T% 9 111 Bags sand/gravet <br /> MiX Ratios S 49s Filter Pack c/siz ��—Ltm� e��� <br /> installation Method -} 9!4'ftl-ti-v <br /> Quantity Installed eern�urge Block: <br /> ry -24941/4,LsDiscussed vrith geologist: - ((y/n ) <br /> EH 29 29. <br /> )4" Type of metliod x o ne r - oYe Pf <br /> 7 PV Gold G�,! b-ewy6o �� <br /> o�� debet s <br />