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ONITORING WELL INSTALLATION UP* <br /> Date: �9 CI CONSTRUCTION Mw Mvuq <br /> II ^ /NW 2 <br /> Premise Address: rr t Q 1 Un�L r CV h1V t/ C- � Total Depth `�`{. 2 y 2 ►t9� <br /> Screen Length (from) ' ' (to) Q <br /> Well No.: tv w MW Filter Pack (from) (to) <br /> Bentonite (from) (to)77T7= <br /> Inspector: Grout (from) % (to) D <br /> Drilling rig type r'N1l✓ <br /> Permit No. Auger O.D. I.D. <br /> � � p c tsne o n <br /> circle oe) <br /> Drilling`Crompany: Completion - Stove pi <br /> Driller: CM casing <br /> ( ^ he_ght <br /> IFr77T <br /> Consultant �dt '`'J'(`/�,(t T <br /> Geologist ABO��gp T <br /> GOWLSfION CY-80X <br /> COOMPLMPLETION <br /> SPECIAL PERMIT INFO. Ground Swiaea <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n <br /> ft. <br /> L3hIf yes, location and distance - . <br /> K. _ <br /> Y•. <br /> a — m <br /> — e <br /> SAMPLING slonai — <br /> _- <br /> aocicn <br /> HoldingTemperature _ 73 Pack <br /> Method 0 Gtln�i �-5 <br /> Screening Method <br /> Tracking Sheet - (y/ n ) ` <br /> SPOILS <br /> Storage Method du JM MATERIALS/DEVEI.OPMENT <br /> Contamination Noted - y n ) �tvC <br /> Storage Location Casing type <br /> Blankft. Screen, 1_ ft. <br /> Slot size 2 <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water �2 — �� Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method 1JJU Surge Block: - ( y 161A <br /> Quantity Installed et.k-� Discussed with geologist:�n ) <br /> Type ofthod (fbet <br /> es <br /> EH 29 29 � Gull (� <br /> i �fly �c0 G 4 (b 6 <br /> j�o F6nl Q,�c c{ N W,fctc fi ca PUbt tL(�ov�S <br /> �o ', IVA- bA C+ 62 wCt.s (N4 60-s( a'e of kwj 0)%e(i �& to'riw-m! <br />