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MONITORING WELL INSTALLATION REPORT <br /> Date: -3o --ZolZ..- CONSTRUCTION <br /> Premise Address: 3Ot5�1�`riu� ck '^ Total Depth <br /> Screen Length (from) 40 (to) 5<7 <br /> Well No.: '�AA W"5 Filter Pack (from) 37 (to) 50 <br /> Bentonite (from) 35 (to) 34 <br /> Inspector: Grout (from) O (to) 3S <br /> Drilling rig type Cn,e 95 <br /> Permit No. 00(o S201 Auger O.D. I.D. Out <br /> Completion - tove pie christie box (circle one) <br /> Drilling Company: Cz c Sa. vA«L <br /> Driller: 72)y'b '5317,Z:14 casing <br /> _ height <br /> 34 <br /> Consultan <br /> Geologist Mkt l - t <br /> ABOVE—GRCUND <br /> toll <br /> OCWLEi ON C gR1STY-80X <br /> COMPLETION <br /> SPECIAL PERMIT INFO. t,,---- GroundSuface <br /> 44-0 Distance to sewer line � grout. <br /> Domestic well on site - (y A(—A3 I 35 <br /> If yes, location and distance - ft. <br /> eft. <br /> — o <br /> SAMPLING dared — <br /> Holding Temperature 4 d- <br /> Method t:n`I 4�a d 1. �r: S4 C. a & <br /> Screening Method It —� t <br /> Tracking Sheet - /n) 7. <br /> Sc ft. = So tt. <br /> SPOILS <br /> Storage Method bvN%Hv. Y011r-aW MATERIALS/DEVELOPMENT <br /> Contamination Noted - ©/n ) <br /> Storage Location rvff4k., ;L& SVk- Casing type 7" Se)Ae „L 40 Pve <br /> Blank 4^b ft. Screen 10 ff. <br /> Slot size 0.0%n It <br /> GROUTING Bags cement lm, 4.'A lb <br /> Buckets bentonite___I_ So lb <br /> Depth to water _ Bags sand/gravel 4 So lb <br /> Mix Ratios 94 l 5 �w+�s Filter Pack type/size Nkpwkevw 21b <br /> Installation Method Wj r '�vtMwSe Surge Block: - QY n ) <br /> Quantity Installed Discussed with geologist: - (0/ n ) <br /> Type of method c� -a Yt3 5.,.%��w �_ <br /> EH 29 29 <br />