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OONITORING LL JNSTALLATION REPS <br /> 5 <br /> 4 <br /> Date: 15 ,-12 _4 CONSTRUCTION <br /> 400\W <br /> PremiseAddress: Total l2 G <br /> Depth <br /> Mw Zo3B /1- Screen Length (from) (to) <br /> Well No.: IV 1 l Filter Pack (from) (to) <br /> Bentonite (from)—(to)- <br /> Inspector: <br /> from) (to)Inspector: Grout (from)—(to)- <br /> Drilling <br /> from) (to)Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> 88 Completion - Stove pipe/christie box (circle one) <br /> Drilling Company. <br /> R06 <br /> Driller: Rob �YOcdeA 8ot,),, cif Ds (F casing <br /> jffT <br /> height <br /> Consultant <br /> Geologist � rOS'4 Cly Chv'15 A:niir 94 _ �' <br /> -PrAue a Ce�L H,u^SI Q4' II" ABOVE-CFWND CHRlM43OX <br /> �1✓v U>^� 1 v. ' -' �Jlv�o•�1 tc�-e' - ., DMPLET1CN COMPLETION <br /> SPECIAL PERMIT INFO. A/ Ground S�xa <br /> Distance to sewer line f t f to 1 grout <br /> Domestic well on site - (y/n ) i, _ <br /> ft. <br /> If yes, location and distance - <br /> ft. <br /> tu' ft. <br /> • 113'bar `Yq � - m <br /> c <br /> SAMPLING tzt'to" slotted c <br /> N soon = a <br /> Holding Temperature _ t23 - gravelpadc <br /> Method a __ <br /> Screening Method tZL <br /> Tracking Sheet - (y/ n ) <br /> �✓hPI-Q5 Co(l.¢C�C cI C�ur�vG }t. - fL <br /> SPOILS \h` tAbort V�5 J <br /> J 140' <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) 2 I �v L <br /> Storage Location 1pe.tqt�c1 VL%V(a5T 5 Casing type <br /> t-tn 5tDr4 HCO, Blank ft. Screen018-0)(OwA) ft � <br /> Slot size $6 Z. 1 <br /> GROUTING Bags cement <br /> Buckets bentonite "5-2 2• l' <br /> Depth to water N 45 ` Bags sand/gravel <br /> . <br /> Mix Ratios t4?Ib 4 41D ' b 'dU Filter Pack type/ ' e I G <br /> Installation Method @ Surge Block: - Se n ) <br /> Quantity Inst tM Discussed with ologist: - U/n ) <br /> �YI� " a of method Ba 11t <br /> EH 92 9 5 '1t`KJCc R �.�� / 5� �aQ - -30 .zc tic 14 uK. <br /> NO)J 1psY4K ruec0.tufOk lot-1 <br /> (o•.U5 �(1��y'.e.d co-h,.ant , �,,ro„1•ecl w�35` tremrnte <br />