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&ONITORING WELL INSTALLATION REPS <br /> Date: aS Ay,l tc,c,--�- - A concluc;Yur 6_ CO SN�TRucrloN <br /> lAVv co(v CL.4- 7 <br /> Premise Address: LAN-00�£� by,c�yz Total Depth <br /> Mw 3ooG Screen Length (from) (to) <br /> Well No.: Filter Pack <br /> (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type_ (Vlud�l o- ?r <br /> Permit No. Auger O.D. 2y I.D. <br /> Drilling Company: <br /> WZCV'-' J)�-t I I✓1 Completion - Stove pipe/christie box (circle one) <br /> J � <br /> Driller: 9�kck Aa casing <br /> ''^ '',, <br /> Consultant_�y (Y�t - �lC F--Q e?coil height <br /> Geologist l V LLL ' LP V-'O _QW-F <br /> CY oc L-TI'�VX-t- �eV4SV�cJ r OC. ACONFLCND <br /> COMPLETION CHAISTY-BOX <br /> SPECIAL PERMIT INFO. GroundAxo COMPLETION 3u <br /> Distance to sewer line l ` grout <br /> Domestic well on site - (y/ O <br /> ib <br /> "If yes, location and distance - JSiI So�J` ft. <br /> tt. ft. <br /> " dk-,Il�d ro �y <br /> 04" dY lied <br /> SAMPLING -PuSheA coria✓ m,(V—' <br /> leg'3" to 6q` krSS slax�on <br /> Holding Temperature_ <br /> Method gnVW Pack <br /> Screening Method = <br /> Tracking Sheet - ( y/ n ) <br /> x' — <br /> n. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) 1 <br /> Storage Location 1 1I h T <br /> QQ-n " l Casing type <br /> Blank ft. Screen ft. <br /> GROUTING No yyLQq�r�� Slot size <br /> Bags cement <br /> yin Buckets bentonite <br /> Depth to water 1 Y 1IV Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - ( y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/n ) <br /> EH 29 29Type of method <br /> LL— <br /> -e. � 11012 W( 3�yy'x5 C.orducrDl- Casty GNau� <br /> >- �k �Ic�-Fe. -- i00u-Vlc�-s . <br /> "Ill c=lloct �1�205ciw QtPS �ue5 � d'C t 5cov vcfty cas ztr i well <br />