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• NITORING WELL INSTALLATION REpe <br /> Date: �n�2(/ 4 CONSTRUCTION <br /> Premise Address: 6 Total Depth 33.3 •�� <br /> Screen Length (from) V-3 ' (to) 2?r <br /> Well No.: MW- 5 Filter Pack (from) • 3 (to) 20.5 ' <br /> Bentonite (from) Zo S- <br /> Inspector: _ Godlrl'e4 69INL ,ICL Grout (from) Su (to) tgT- <br /> Drilling rig type &)z SI <br /> Permit No._ .52 D 07 DE y3 Auger O.D. 711 I.D. 1,2-T " <br /> Completio ove pip /cluistie box (circle one) <br /> Drilling Company: I-)v6A 0'rA pr�tll►,5 <br /> Driller: vt�'- cy- j0'/U"/L1 OA/Wcasing <br /> •3�'�' height: <br /> Consultant G ) V <br /> Geologist •� <br /> ABOVE-GACUND <br /> CO Mie LET{O N CNAISTY-80X <br /> COMPLET1CN <br /> SPECIAL PERMIT INFO. Ground Surfaca <br /> Distance to sewer line <br /> pram <br /> Domestic well on site - (y/ n ) " ft. <br /> If yes, location and distance - ft• <br /> m <br /> d <br /> C <br /> SAMPLING 7�rji��1 alor� Y <br /> r.ac'acn <br /> Holding Temperature V°C v <br /> Method UG&)d(o g'vw F <br /> ack <br /> Screening Method C __ <br /> Tracking Sheet - ( y/ n ) <br /> f4• I rfEo <br /> SPOILS <br /> Storage Method MATERIALS/DEVEI.OPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type SC6. 4P PVA <br /> Blank -t 3' s�'ft. Screen ft. <br /> Slot size .07, tri <br /> GROUTING Bags cement 11 (5h---vim ) <br /> Buckets bentonite I—Z 6tA„g Sa 16. oar fx s <br /> Depth to wate`r__�$_��� Bags sand/gravel <br /> Mix Ratios �g4(6j V]_b Filter Pack type/size 40� 5 n-1 <br /> Installation Method DV � Surge Block: - ( y/40) <br /> Quantity Installed-- Discussed with w s - (O/ n ) <br /> Type of mediod <br /> EH 29 29 <br /> J <br />