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N,.,iNITORING WELL INSTALLATION REPOI",r <br /> Date: CONSTRUCTION <br /> Premise Address: c2lb /'3 Zn%.t #a, Total Depth s <br /> Screen Length (from)- _(to) z. <br /> Well No.: i5W ` Filter Pack (from) (to) <br /> � Bentonite (from) 4! (to) 33 ` <br /> Inspector. 1/i . Grout (from) 33 <br /> (to)_ <br /> Drilling rig type B X —8 1 <br /> Permit No. �i D S-d 9 G 2 Auger O.D. a/,n „h I.D. G X '/ <br /> Completion - Stove pipeYiristie box (circle one) <br /> Drilling Company: W . �Dr► h <br /> Driller:_ Fr 'RQ m i r eZcasing <br /> 4 J,,a Ir!'6}�iLGo height <br /> Consultant 1 r7'c S1 JA.G <br /> V <br /> Geologist_ Jne A ne),w(a <br /> ABOVE-GACUNO <br /> COMPLETION (bOON <br /> SPECIAL PERMIT INFO. Ground Swface <br /> Distance to sewer line S / Si7u Oreut <br /> Domestic well on site - (y On <br /> 33 <br /> If yes, location and distance - � <br /> 41- yz f n. <br /> +V .sere _ <br /> No P I d7 R"d — <br /> SAMPLING — n b fie o .lorai _ <br /> aoc1cn <br /> Holding Temperature AIA = <br /> Pack <br /> Method �e,� �Grl)d -- ¢'Ylw <br /> Screening Method444 <br /> Tracking Sheet - (y/ n) <br /> % <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (a n) <br /> Storage Location DY►���-c, Casing type ")- � n� P V�i <br /> Blank 2— ft. Screen 2— <br /> Slot <br /> Slot size 0 2.0 rL e <br /> GROUTING Bags cement ba d-r a LIt <br /> Buckets bentonite /vim "�— <br /> Depth to water Bags sand/gravel < 10 D I bet �� <br /> Mix Ratios a. 1 k e- (-94-1b),,)4, 60,a,4int,s HO Filter Pack type/size <br /> Installation Method G oy t -o✓a 1, 01 <br /> . Surge Block: - (Y/n <br /> Quantity installed a-n 1-)a ,, , Discussed with geologist: - n ) <br /> Type of method Al A <br /> EH 29 29 b l Vvj_+r C,k, <br />