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d . <br /> JNITORING WELL INSTALLATION REPOn <br /> Slz�f�r <br /> Date: Leo 1 tS 12tmf Lx�w*j_ L4_ CONSTRUCTION <br /> Premise Address: R , , Total Depth <br /> Screen-Length (from) (to) <br /> Well No. M - 2 _ Filter Pack (from) (to) <br /> Bentonite' (from) (to) <br /> Inspector: l Grout (from) n-_ (to) �-- <br /> .. Drilling rig type ct� (SS <br /> Permit No. Auger O.D. I.D. <br /> .- <br /> yCompletion - Stove pipe/du istie box_ (circle one) <br /> Drilling Company: <br /> w <br /> Driller. '' cas inq <br /> 'height <br /> Consultant �Ik' -•-- - <br /> 11 <br /> Geologist- 3- <br /> /FMVE-GROUND-3 <br /> COCHR t5TY8C3Xf <br /> fvPLfiTlON COMPLETION <br /> SPECIAL PERMIT INFO, k� Ground Surface <br /> r <br /> Distance to sewer line y�� r grout <br /> Domestic well on site - (y/9) . . <br /> If yes, location and distance - ft. <br /> • V r � <br /> SAMPLING sior',ad C <br /> �o _ <br /> Holding Temperature G w <br /> Method C►2u5 7 tiG.� _ �`� <br /> Screening Method Nca <br /> 'tracking Sheet n ) <br /> M <br /> SPOILS _ <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - {y/ n} �,, 5uk 40 �� <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size O <br /> GROUTING Bags cement:_ <br /> • Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios ' 2 GsrAfsr� alter Pack type/size 1.0T� _ <br /> Installation Method as t urge Block: - (6)/ n ) <br /> Quantity Installed Discussed with geologist: - G/ n ) <br /> Type of method ` &VA/ MtLs Oi ) <br /> EH 29 29 <br />