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i ONITORING WELL INSTALLATION REPOnPI <br /> Date: I���3'0CONSTRUCTION <br /> O Total Depth �G <br /> Premise Address: OOOL�/, /�e{�D ` <br /> Well No.: /Ls�3 Screen Length (from) b (to) 53 <br /> Filter Pack (from) -1& (to)7Bento — <br /> Inspector: Grout (from) <br /> (from) <br /> (from)TJ U —(to) 3 <br /> Drilling rig type c` 5 <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: LK Completion - Stove pipe/christie box (circle one) <br /> Driller: %( 1 r"/�7- v/&< casing <br /> Consultant lir� <br /> U /� height <br /> �� <br /> Geologistds/X/N�/l 0 0�`v`� T <br /> ABOVE-GROUND <br /> CO&FLETION CHMM-BOX <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line J'U grout <br /> Domestic well on site - (ys <br /> n o <br /> If yes, location and distance l ft. <br /> = m <br /> — o <br /> _ <br /> — c <br /> SAMPLING <br /> slotted = _ 8 <br /> tarion '- <br /> Holding Temperature )Lo C6-4' ��y/Ad ^i° 31r'lsG� - Sr+valPack <br /> Method 6'Le .T — <br /> Screening Method ? __ <br /> Tracking Sheet - y n ) <br /> SPOILS / <br /> Storage Method brX f 9AC-e MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y /- <br /> Storage Location X4 ii.P4..-cat' Casing type 2 PV <br /> Blank S 3 ft. Screen <br /> Slot size ' Oto <br /> GROUTING Sags cement //Y49'7-'9 <br /> Buckets bentonite_ <br /> Depth to water Bagssand/ tL 1'5&) <br /> Mix Ratios 1 `l 11/✓ Filter Pack type/size z <br /> Installation Method " ,v w+t Surge Block: - (y C n) <br /> Quantity Installed26 Z e_&W CLO yjt�.�) Discussed with geologi t: - (y <br /> EH 29 29 � <br /> Type of method N <br /> //�31b6 /4S- 03 <br />