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- MONITORING WELL INSTALLATION REPO f <br /> Date: l/Y D J(Rty7le-z- 02 r,,2 d CONSTRUCTION <br /> � -�^ '- � r <br /> Premise Address: ,�r2o2 4 mo Total Depth <br /> Screen Length (from) (to) .S' <br /> Well No.: VW -3 -4- \/VV - Z. Filter Pack (from) Y I <br /> V" 0 <br /> Bentonite (from) �/ ' (to) 31 <br /> Inspector: VV Grout (from) ? ' (to) S 0 rLL L� <br /> Drilling rig type__ L. ,�4 (L G 6 iy D� <br /> Permit No._ b04, 3711 Auger O.D. <br /> Completion - Stove pi e/christie (circle o <br /> Drilling Company:_ ri 1 1 i n P <br /> Driller: <br /> _ /`�oylmd✓1 19v✓)2_tru casing <br /> CAr/0S nl oreno� ErrjQrffre//4 a- A;ir4w1 height <br /> Consultant J ` 4Oart vEZ 7 <br /> Geologist Lu i S Gorde-a —AGUE •- <br /> ABOVE-GROUND <br /> COMWLETION X <br /> SPECIAL PERMIT INFO. Ground Surfa COMPLETION <br /> x <br /> Distance to sewer line_ grout <br /> Domestic well on site - ( y/0 ft <br /> If yes, location and distance - <br /> ft. <br /> Cal <br /> O <br /> zo ' m <br /> SAMPLING .Y_ <br /> slotted <br /> soc3on = <br /> Holding Temperature <br /> Method I Lr� ,L G"/�,� gavel pack <br /> Screening Method <br /> Tracking Sheet y ) ND yy 20 bs <br /> �O ft. =� = n. <br /> SPOILS <br /> Storage Method 51, ` Y, MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n <br /> Stora e Location Qom, <br /> g •�( Casing type � L'�J0 11 k rc �v� <br /> Blank .- ft. een /„— ft. <br /> u <br /> Slot size 6). 030 <br /> GROUTING Bags cement /b b v4 rets IYJML <br /> Buckets bentonite /04 <br /> Depth to water J/ '7 ' Bags sand/gravel 7/V�A1 z <br /> Mix Ratios GJ -�z /,S Filter Pack type/size 3 �,'� <br /> Installation Meth 5- /vim. -h M4kc Surge Block: - ( y n <br /> Quantity Installed .? N0z<eAr-3 o e.rn 4"gavf Discussed with geo ogist: - y n ) L <br /> Type of method <br /> EH 29 29 <br />