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�'-,.ONITORING WELL INSTALLATION REPG.,,4 <br /> Date: 6111 -91 CONSTRUCTION <br /> Premise Address:_ I54an&-&vA Total Depth l <br /> M Screen Length (from) 3. (to) <br /> Well No.: 1 l / Filter Pack (from) (to) A <br /> �n nom` /S io Bentonite (from)�(to)_L��___ <br /> Inspector. 1 `F p Grout (from)—(to)—Cz� <br /> Permit No._ l ll <br /> �2 a p p D Drilling rig type {i S-�. M o V%Lo <br /> Auger O.D. 3%2 I.D. 3 <br /> Drilling CoK hQ V�1 Completion - Stove pipe/ tstie bo circle one) <br /> m 1 (1 � //�� <br /> Driller: @U1��_�-Cx'1N K M& O'roCy(er— casing <br /> 6-rr � height <br /> —EWT <br /> Consultant V <br /> Geologist <br /> ABOVE•GRCUND CNAISIY�OX <br /> COI.f�LETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surtax rr <br /> Distance to sewer line �� grout <br /> Domestic well on site - (y/V 3 6 It. <br /> If yes, location and distance - ft. <br /> SAMPLING sloCad = c <br /> ^^ aacicn '- — <br /> Holding Temperature ff (J�� <br /> PaCK <br /> Method <br /> Screening Method PIP <br /> Tracking Sheet - (y/ n ) <br /> SPOILS <br /> Storage Method 9 L_ kL MATERIALS/DEVELOPMENT <br /> Contamination Noted • t y/n <br /> Storage Location Abt1 I 0 I'll of V504r1Casing type �� 2 <br /> Blank 43 fr. Screen 30 ft. <br /> Slot size . OZ <br /> GROUTING Bags cement <br /> I Buckets bentonite <br /> Depth to water 1 Bags sand/gravel 11 <br /> Mix Ratios 5 V i Filter Pack type/size ' <br /> Installation Method 7J� rp Surge Block: - ( y n <br /> Quantity Installed Discussed with geologist: - On ) <br /> n ) <br /> Type of method <br /> EH 29 29 <br />