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NITORING WELL INSTALLATION REI <br /> Date:_ 211 4 CONSTRUCTION <br /> Premise Address: V6 fboS'�T,�f�CK Total Depth I <br /> p Screen Length (from) 1 (to) I D <br /> Well No.: M�_51 Filter Pack (from) I (to)--?�� <br /> Bentonite (from) 7, 7 (to) y- 3 <br /> Inspector: Grout (from) Svrfew (to) 'J.3 ' <br /> Drilling rig type Se–'81 <br /> Permit No. 52 .0 d 144' Auger O.D._ '' I.D.__ (4,Z <br /> Completion Stove pipe lu-istie box (circle one) <br /> Drilling Company: WOUdN'OIrO� <br /> Driller: casing <br /> heighj_ <br /> Consultant rk S <br /> Geologist_ L�8 lij Jki�G S -� <br /> ASOVE-GACUND <br /> COMPLETION CNAISTY-80X <br /> COMPLETICN <br /> SPECIAL PERMIT INFO. Ground Surfacs <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) 4'3 fL <br /> If yes, location and distance - fi- <br /> t <br /> — m <br /> SAMPLING yo, sp� I alACvd `'° <br /> Holding Temperature <br /> Method JCC&o6l:Pt _ <br /> Screening Method <br /> Tracking Sheet - ( y/ n ) <br /> SPOILS <br /> Storage Method 5.: W1 MATERIALS/IDEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location ( y Casing type SC k 4 0 VVI <br /> Blank I U t3 �o►tift. Screen S ft. <br /> Slot size , 02 Ihth:GS <br /> GROUTING Bags cement y 1 d 7165, PAI.h w/ 3 i4'w weds <br /> rr � Buckets bentonite f-z S Si 4.C" <br /> Depth to water b Bags sand/gravel 3jS <br /> Mix Ratios Filter Pack type/size 41'; <br /> Installation Method �_ „9uSurge Block: - ( y/0 ) <br /> Quantity Installed__ Discussed with geologist: n ) <br /> Type of method <br /> EH 29 29 <br />