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NITORING WELL INSTALLATION REP( <br /> Date: iaL?V/y CONSTRUCTION <br /> 206 �� S-+ S40cr�, ' <br /> Premise Address: �_•, Total Depth ��. 3 <br /> Screen Length (from) 11, 3 <br /> Well No.: fVl(nl'lJ Filter Pack (from) 1 . 3 (to) S <br /> GAbn,�l Bentonite (from) (to) I.,S <br /> Inspector: N'La�GZ Grout (from) Lvfkef,e <br /> Drilling rig type 13l=B f � <br /> Permit No. <br /> Auger O.D._ °� I.D. 4•y '' <br /> r�o�W�� Completion vep /ochristie box (circle one) <br /> Drilling Company: W <br /> Driller: ��'"`� t 1041casing <br /> �) FMI height: <br /> ConsultantR v <br /> Geologist L�is�1�� S�r`e�(�S -� 170 ABOVE-GRCUNO CNAISTY-80X <br /> COh�i'L ETION COMPLETICN <br /> SPECIAL PERMIT INFO. Ground Suriacs <br /> Distance to sever line prccrt <br /> Domestic well on site - (y/ n ) !' ft. <br /> If yes, location and distance - r ft. <br /> v 0 <br /> S:• q <br /> SAMPLING <br /> zoc*n <br /> Holding Temperature <br /> Method 1 CC t C&A4 o F <br /> Screening Method ` -- <br /> Tracking Sheet ( y/ nL) _ <br /> '!-3.3 �t. _ ��• 3� tto <br /> SPOILS <br /> Storage Method 1 /kWnf MATERIALSfDEVELOPMENT <br /> Contamination Noted - ( y/ n ) <br /> Storage Location 0n91 Casing type SCh' y� PlC <br /> Blank X? Screen <br /> Slot size '07 jhdW S <br /> GROUTING Bags cement )L '-7 b•fir, sq,r� �✓/ ? p� <br /> Buckets bentonite bob S'Olb. <br /> Depth to water �i�� I Bags sand,/gravel 3 jags 90 <br /> Mix Ratios Filter Pack type/size .f 3 <br /> Installation Method_ _ Surge Block: - ( y/b) <br /> Quantity Installed Discussed with geologist: - <br /> Type of method <br /> EH 29 29 <br />