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MONITORING WELL INSTALLATION REPORT <br /> Date: 30' 2012— CONSTRUCTION <br /> Premise Address: 3D15 Irl awT>ntu .56*-),, Total Depth_ <br /> Screen Length (from) RA (to)_ 35 <br /> Well No.: M W–S5 Filter Pack (from) 23 (to) 35 <br /> Bentonite (from) 25 (to) W; <br /> Inspector: TeA ?a 3io, J05 Grout (from) O (to) 75 <br /> Drilling rig type CME 95 <br /> Permit No. 00(.5201 Auger O.D. 1 4' I.D. <br /> Drilling 4" <br /> n�S C2d.e.�il�:r� Completion- rove pi christie box (circle one) <br /> Company: �- . <br /> Driller:_ 10W �2�a2.�,xfcasing <br /> 3$ height <br /> Consultant �vtyirov+rw n ¢<1 ..lou C1w p�Svc . y �4 Yi" <br /> Geologist Wkike. 14ll _ <br /> ABOVE-GROUND Cl-ffI1SN-80X <br /> COt,'PL.ETiON COMPLETION <br /> SPECIAL PERMIT INFO. G=rd suit <br /> Distance to sewer line grout. <br /> Domestic well on site - (y 1 25 _ il <br /> If yes, location and distance - <br /> 3n ft' <br /> — a <br /> — m <br /> — n <br /> — m <br /> SAMPLING <br /> Nvv.a dotted - S <br /> Holding Temperature „u _ P <br /> Method ' = <br /> Screening Method <br /> Tracking Sheet - (y/n) _ <br /> 3-5 <br /> SPOILS n <br /> Storage Method Or%S'A C rOki-o'r? <br /> 6 � MATERIALS/DEVELOPMENT <br /> Contamination Noted - n <br /> Storage Location V%0 44. 4�bf o'f Casing type Z` SelnarL%le NC- <br /> Blank <br /> '`ILBlank 30 ft. Screen_ 5 --ft. <br /> Slot size ©-mc;'o <br /> GROUTING Bags cement 9 4R 16 <br /> Buckets bentonite- I <br /> Depth to water �^ Bags sand/gravel (a <br /> Mix Ratios 94-llis 5 gApb Filter Packtype/size hln,,.ley�c <br /> Installation Method�v �Ytcmr i+e Surge Block: - �/n ) <br /> Quantity Installed allows Discussed with geologist: - ((�J/ n) <br /> Type of method 5*wc#k v q 8w�aval STP <br /> EH 29 29 <br />