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MONITORING WELL INSTALLATION REPO, <br /> Date: `l ' I-4' ` 2— 11 11 CONSTRUCTION <br /> Premise Address: 2g01 I�LIS- ()V Total Depth 80 <br /> Well No.: C W Screen Length (from) Z5 (to) YO <br /> Filter Pack (from) 80 (to) 7.1 <br /> Bentonite (from) � � (to) (Q.3 <br /> Inspector. S Grout (from)�(to) <br /> l Z 21� C Drilling rig type <br /> Permit No, f�' Auger O.D. OH <br /> n Completion - Stove pi christie box (circle one) <br /> Drilling Company: ( l <br /> Driller: noel S�vP ✓� We�I <br /> casing <br /> Consultant K(SL <br /> '/ �_, r` _� '� f�,,,,' 1 vheight <br /> Lvkkb —Q <br /> Geologist d V\rA booty) _ W <br /> ABOVE•GACUND CHFi15TY 80X <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. GroundSurface <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n) 3 R. <br /> If yes, location and distance - <br /> .J.=ft. ft. <br /> SAMPLING �Q SoII �vy\PLJ Ss <br /> .P'V c'( A 0h�1�515 do lc <br /> CVv = 8 <br /> `I socn 'r <br /> Holding Temperature 7 <br /> Method '"' _ V1%*W Pack <br /> N. <br /> Screening Method '" -_ <br /> Tracking Sheet - (y/ n ) — <br /> �Ltt• <br /> SPOILS LL, cc1�,,� <br /> Storage Method_ 7U �" �71( f MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y n /J <br /> Storage Location t lV� �� Casing tJype 111 <br /> W 11 l Blank I ft. Screen ft. <br /> Slot size . a1O ivQ, rc <br /> GROUTING Bags cement ¢Wigit <br /> Buckets bentonite WL) <br /> Depth to wa er 2 • ''nn Bags sand/gravel ' <br /> Mix Ratios 47VbAk 1l 1Filter Pack typene�j2 <br /> Installation Method • V Surge Block: - y n ) <br /> Quantity Installed Discussed with geolo ist: - (y/ n ) <br /> EH 29 29 Type of method rt Ay( c <br /> 5 3 <br />