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MONITORING WELL INSTALLATION REPORT <br /> Date:_ "2-6 -13 CONSTRUCTION <br /> Premise Address: ✓1dS 1'r iali'b�I<TD Total Depth 3 S <br /> Screen Length (from)' I q (to) 3i4 <br /> Well No.: k W- L, - Lf -r,; Filtet Pack <br /> (from) Il0 (to)-�(to) t} <br /> Bentonite' (from) 13 1 <br /> Inspector: � /0�4T Grout (from) - _ <br /> (to) <br /> Drilling rig type g(j DIl a 4 Q <br /> Permit No. 5-9,06e7 228 Auger O.D. C1'" I, <br /> Completion - Stove pipe •stie box (circle one) <br /> Drilling Company:_ � ��� ��►((„��, <br /> Driller:_ k Anj� casing <br /> height <br /> ConsultantPI hhdL� �V • <br /> Geologist <br /> ABOVE-GROUND <br /> bMSPLETON C}iRLM-Sox <br /> SPECIAL PERMIT INFO. COMPLE'f]ON <br /> C{rnttnd Surface <br /> Distance to sewer line V h grout <br /> Domestic well on site - (y n <br /> If yes, location and distance - (t. <br /> - � O <br /> - _ r <br /> SAMPLING — o <br /> taction - <br /> Holding Temperature <br /> Method _= gravel Pack <br /> Screening Method = <br /> Tracking Sheet - (y/n) _ <br /> '�y n. -~• 3 tt. ' <br /> SPOILS <br /> Storage Method f)1%4rn S MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y n LL <br /> Storage Location 0 A 5� >�i Casing type_ 5L-h * PV c <br /> Blank 19 ft. Screen IS ft. <br /> Slot size_ 0, 010 <br /> GROUTING Bags cement 4aw, <br /> Buckets bentonite_ /7(y)AA5�ntr <br /> Depth twater Bags sand/gravel_ (,ox/0o 4kyr <br /> Mix Ratios Filter Pack type/size 2-117 <br /> Installation Method _ _ Surge.Block:___(_y_/n_)__ <br /> Quantity Installed Discussed with_ geologist: - (y/ n ) <br /> EH 29 29 <br /> Type of method <br />