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MONITORING WELL INSTALLATION REPORT <br /> Date: �' /�( 13 CONSTRUCTION <br /> / !� od U f7�6C <br /> Premise Address: � � Total Depth 1� <br /> Screen Length (from) 71 'd SI (to) 41'd yr' <br /> Well No.: -TW-34 Filter Pack (from) 73" d 53 (to) 51 38" <br /> 14Kur-I Bentonite (from) 59'* 38- (to)S6'+ 3S� . <br /> Inspector: Grout (from)---3-7-- (to) <br /> Drilling rig type SrJNI< <br /> Permit No. Auger O.D. lo' I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: CAICI-- 11P <br /> Driller: Nom HVn(rE2 casing <br /> height <br /> Consultant <br /> Geologist 3(ziA(v / w-Ef - T <br /> ABOVE-GROUND CFWISTY80X <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Srafaca <br /> Distance to sewer line grout 3z <br /> Domestic well on site - (y/n) .�S,34' CenH n <br /> If yes, location and distance - <br /> 41. y 59' h. <br /> y _ . <br /> o <br /> SAMPLING abttad '-' <br /> :a <br /> - wc7on —_ <br /> Holding Temperature_ „ -_ ,I p <br /> Method c <br /> Screening Method <br /> Tracking Sheet - (y/n) it. <br /> 7) � SJg — 73 Sg� <br /> SPOILS <br /> Storage Method roll rte' 9% nS MATERIALS/DEVELOPMENT <br /> Contamination Noted - (5)/n) <br /> Storage Location yru" C.-eo` Casing type 50"N go PVC <br /> F <br /> Blank G t 4Z' ft. Screen <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel Z 8 3�ti� <br /> Mix Ratios Filter Pack type/sizeh 2 <br /> Installation Method Surge Block: - 6W n—) <br /> Quantity Installed Discussed with geologist: - (y/n) <br /> Type of method <br /> EH 29 29 <br />