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&ONITORING WELL INSTALLATION REa <br /> Date: 4-• 8 I -4 CONSTRUCTION <br /> $erljgyn�n HD It' . '49-�9 <br /> Premise Address: L-I✓1Colvl Cjo hoo RC&- Total Depth �/ blah 51 +l+4p <br /> Screen Length (from) 5 (to) -3-3 <br /> Well No.: MWI D(P Pr Filter Pack (from) S5 (to) --Y9 <br /> ^, Bentonite (from) 59 (to) 55 <br /> Inspector: Grout (from) o (to) 55 <br /> Drilling rig type <br /> Permit No. Auger O.D. 12a <br /> C `11 i n Completion - Stove pipe Christie box (circle one) <br /> Drilling Company:�J `� <br /> / fob 1 <br /> Driller: �.hr15 �{^. �12✓✓�i l <br /> -Jo 5e jffT casing <br /> f� �� nn height <br /> Consultant I..�V1VU • <kR t�C'9 <br /> GeologistVM IV <br /> —E <br /> �5{t°✓ " - T <br /> hl5o% KP --1-t �u2-- 0e-nSV)r1LJi- ASABOVEGROUND CHMSY-BOX <br /> COMPL�ION CCMPLETICN <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line N /R grout <br /> Domestic well on site -- (yam r-j�) tt <br /> If yes, location and distance - 1 <br /> — a <br /> = m <br /> — e <br /> SAMPLING GVRW QCB �-RqJ slotted <br /> sect on — 8 <br /> Holding Temperature T = gravepack <br /> Method — <br /> Screening Method P t DPP U t <br /> Tracking Sheet - ( y/ n ) _ <br /> 'J Co1 <br /> so1I 5a'v-?L, s Lvc> r �� <br /> SPOILS 1-Voics orItr- <br /> �ir ✓� �crfY7L � <br /> Storage Method 5 ys MATERIALS/DEVELOPMENT I <br /> Contamination Noted - (y/ n ) 5 (vlI¢SS S p I / r7y�- <br /> Storage Location Soo-rh of >?<1y less Casing type <br /> Blank� (p PyGh. Screeno }eel fr. <br /> Slot size <br /> GROUTING Bags cement 9k lb TJD2 <br /> tir Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/ 'ze <br /> Installation Method Surge Block: - / n ) <br /> Quantity Installed Vj M%4e-5 3 CG-U'V� Discussed with geologist: - 0/ n ) I <br /> ^' 4 (b b4jfbr,1C.Fowdet' Type of method 5JmvtbUYAd - +' ,h 21 LG <br /> EH 29 29 Irg� I �L0 <br />