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MONITORING WELL INSTALLATION REPORT <br /> Date: Zolz CONSTRUCTION <br /> Premise Address: 306_ 5 RN (7rwk 4s ,CA Total Depth <br /> Screen Length (from) 55 (to) 60 <br /> Well No.: jyku) _4 C Filter Pack (from) !i I (to)- 6 n <br /> Bentonite (from) 49 (to) <br /> Inspector: :tad, aaoi,ta As Grout Cfrom) 0 (to) 9.9 <br /> Drilling rig type Cln.tt 95 <br /> Permit No. 00 65201 Auger O.D. t' I.D. V41 " <br /> 1 Completion Stove pip chnstie box (circle one) <br /> Drilling Company: C2sc2&e �v,t�t�a t L• <br /> Driller: 7 nr� Szlazzv casing <br /> /� height <br /> u <br /> Consultantr'.5ver e hU Tact_ loc; r 64wr31 " <br /> Geologist (')t 4 Blau <br /> ABOVE-GROUND <br /> COMPLETION CNAIS7Y-60X <br /> COMPLETION <br /> SPECIAL PERMIT INFO. nn Grwtd SLwlx . <br /> Distance to sewer line__ Au t`t- grout. <br /> Domestic well on site - (y ) <br /> If yes, location and distance - <br /> SSh. I tt. <br /> •aR: - <br /> -_ m <br /> V <br /> C <br /> SAMPLING �e Toned <br /> ladcn <br /> Holding Temperature <br /> Method �W P <br /> ack <br /> Screening Method = <br /> Tracking Sheet - (y/In _ <br /> SPOILS <br /> Storage MethodOt'tsrt�e rplt MATERIALS/DEVELOPMENT <br /> Contamination Noted - (&n ) <br /> Storage Location hntill s" aQ s l e Casing type -•'* 5 cinel. <br /> Blank-----5,;'—ft. Screen S h. <br /> Slot size 0 ells (.? <br /> GROUTING Bags cement l tb <br /> Buckets bentonite I Sa 1 <br /> Depth to water_ (i1- Bags sand/gravel S 16 <br /> Mix Ratios 91, 16„ 5a61n r Filter Pack type/size <br /> Installation Method�?yt -{ r lry ie Surge Block: - (2' n) �— <br /> Quantity Installed "do �%% o Discussed with geologist: - f®/ n) <br /> Type of method <br /> EH 29 29 <br />