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MONITORING WELL INSTALLATION REPOk'f <br /> Date: N o Ver, ,be r 1, 2y l/ CONSTRUCTION <br /> Premise Address:_ x.224 Mam+lt,U, ko�, Total Depth Z7 <br /> Screen Length (from) _1Z (to) Z <br /> Well No.: Filter Pack (from) 2j„ (to) I <br /> `/ �t Bentonite (from) 23 (to) <br /> Inspector: V,C,k,, �L11Y�-r�[.r� Grout (from) Iq (to)_ <br /> li�_'i;_ <br /> Drilling rig type /.6 0 <br /> Permit No. DOA 3 7 12- Auger O.D. g, 2 ' I.D. , 2 T <br /> Drilling Company:_ <br /> Completion - Stove pipe/christie box (circle one) <br /> �f .S r �Y, 1 �i ,t.c- <br /> Driller: fJ rrn r S��4 i-i UeZ- casing <br /> r/os /Y1ar Ern4rf, Es-y-r-z/!a 1 height <br /> VX <br /> Consultant Aj ybrtG��Lr?�, it�/�,rD ��j1 ��/�C(r <br /> Geologist ��rl�`�l Vi 1�Q�2 le✓� -1G� •- T <br /> ABOVE-GROUND <br /> CO MP LE7 }O N Ct-{A ZTY <br /> COMPLETICN <br /> SPECIAL PERMIT INFO. Gmund Surface <br /> Distance to sewer line_ -/ ) 640 l➢ _ grout well on site - ( y/ n ',ID <br /> - hs / l� <br /> If yes, location and distance - t-, Z� ft.� <br /> ft. <br /> J��'riv D JJ <br /> SAMPLING c4u�IiSa �'i�f� ✓�r <br /> tlottad — � <br /> Holding Temperature71'-w Pack <br /> _ <br /> Method C-ZM <br /> Screening Method -2 7 b� <br /> Tracking Sheet - n ) <br /> �2 ft. ft. i D <br /> SPOILS <br /> Storage Method S -[�`�ir, �rt/r�� MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/� -P Vc- Sc ��c <br /> Storage Location &)i Si Casing type 1 i n A/Lz <br /> Blank ,Z ft. Screen Z <br /> Slot size .0 rm r'G--a <br /> GROUTING Bags cement 31 J <br /> q . Buckets bentonite a <br /> Depth to water / d r ^'1 Bags sand/gravel -!t� - /h t.t o;t s'9 <br /> Mix Ratios }- MA.We, a YIZ4//� Filter Pack type/size %-z- <br /> Installation ethod 1- 1 ,7 ,��# Surge Block: - ( y n <br /> M <br /> Quantity Installed b �,,D,�scussed with geo ogist: - y/ n ) <br /> -d- 1�66 Type of method <br /> EH 29 29 <br />