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MONITORING WELL INSTALLATIC14ORT <br /> Date: 1��� /3 CONSTRUCTION <br /> Premise Address: <br /> P���)"�C f�ON gz>47 Total Depth 707 <br /> Screen Length (from) 35- (to)_6c 'q- <br /> Well <br /> Well No.: tv '2-4 u�/, Filter Pack (from) W 3- (to) 7/ <br /> tt Bentonite' (from) SYK- 3c� (t 3 <br /> 0/ <br /> Inspector: J ,�o•rfK** Grout (from) S2f (to) 7 <br /> 404 ; _3 Dulling rig type 5z;Me <br /> Permit No. Auger O.D. I.D. <br /> Completion- Stove pipe/chr tie box (circle one) <br /> Drilling Company: 0-418ADC <br /> Drillez: f9N(7011/- V0AIk/ casing <br /> /, height <br /> Consultant H til�s�`� `�2� <br /> Geologist g('t/j)jV4 L14PITFJN 14!H <br /> ABOVE-GROUND CHRL-m-BOX <br /> cowPl_E oN COMPLEn'ON <br /> SPECIAL PERMIT INFO. aDund 5Ld'C° <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n) S3•S� g <br /> If yes, location and distance - <br /> SAMPLING zIottad A <br /> taction 'r <br /> Holding Temperature m - VIVE4 pack <br /> Method ` <br /> Screening Method — <br /> Tracking Sheet - (y/n) ` <br /> SPOILS <br /> Storage Method CA Irl (q MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) 2 R" <br /> Storage Location Casin type <br /> Blau 55 4/5--43 ft Screen a S ft. <br /> Slot size <br /> GROUTING Bags cement / <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel 4 yL3nu5R.m IS tGw65 <br /> Mix Ratios Filter Pack type/size <br /> Installation Metho uw2 r� +►i�E ___,_-.urge-Block:_cs�Z <br /> Quantity Installed Z 2u"r' Discussed with geologist: - (y/Q <br /> Type of method <br /> EH 29 29 <br />