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f 0" <br /> MONITORING WELL INSTALLATION REPO <br /> Date:_2 ICONSTRUCTION <br /> Premise Address: �f�LA IG f pyt hoI'�11 Total Depth 3 1 <br /> R Screen Length (from) 2 (to) 1 1 0 <br /> Well No.: o L Filter Pack (from) (to) Ioq <br /> ' t Bentonite (from) 1011 (to)—1 1)b.5 <br /> Inspector: MPS Grout (from) (to) <br /> Drilling rig type Yl kid <br /> Permit No. E Auges O.D. IB" I.D�(Oil <br /> Drilling Company: _ <br /> Completion - Stove pi Christie bo (circle one) <br /> ) — <br /> oy <br /> Driller: Roe 5jArdeCkr� casing <br /> (� n <br /> qlffl 9h <br /> Consultantlogy <br /> �� cad.,Aer <br /> Geologist ( 11 yn C.urD rl <br /> f' �w�e ABOVE-GROUND <br /> �VQ F'D�lei- w' uF_vt5hp til SCC. oasimJ --" `t° COMPLETION COMPLETICN <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Su1x° <br /> Distance to sewer line grout <br /> Domestic well on site - (y/9) ft, <br /> If yes, location and distance - 04 ft. <br /> eft. — <br /> loZ = <br /> SAMPLING slot _ S <br /> Ise 17-5 section _ <br /> Holding Temperature wl�(QC CIJ I l�Y — gravel pack <br /> Method = <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> Slit- <br /> SPOILS 130 <br /> Storage Method LA Q IJI MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y / Sieg sm",ag+*-a <br /> Storage Location Casing type `f a IIIO' �25 + IZ5 130 <br /> Blank <br /> --!!D FVC ft. Screen l5' stern 1x45 ft. <br /> Slot size 01 D <br /> GROUTING Bags cement <br /> 1 Buckets bentonite 1 S�uA 6uckat " �e 1Lut <br /> Depth to water �D Bags sand/gravel a fAz ) ttSr ! <br /> Mix Ratios Filter Pack type/size I C l w st - <br /> Installation Method Surge Block: - 6/ n ) <br /> Quantity Installed Discussed with geologist: - y ) <br /> Upl�b � Som ,� 10 5olb)"5 Typeofinethod b(oci t la � 6elQd <br /> EH 29 29 of �QndtnldC <br /> 1�1t�U) �n I1�o CDvttdavt°✓ 'Ip0"x qo' K l0"W41GL <br /> ti a2q tt�l�VUAt, <br /> CfqLtOky Aa 41h 1�0?. <br /> x a 0�e Erzo 7owyen <br />