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MONITORING WELL INSTALLATION REPORT <br /> Date: ?' –Z6– 2O1Z CONSTRUCTION <br /> Premise Address: 3015 t�aV t`�rtietjt� CA Total Depth 5b <br /> Screen Length (from) A*(to) .rib <br /> WellNo.: Filter Pack (from) 3T (to) 5.Q <br /> Bentonite (from) '35 (to) 31'_ <br /> Inspector: Te.a Grout (from) 0 (to) 35 <br /> Drilling rig type CM CZ 95 <br /> Permit No. 0-0 fo S 2 o I Auger O.D. I.D. 4 %– c e o <br /> Completion Stove pip clttistie box (circle one) <br /> Drilling Company; Lzstac�bri��,tiv }L•P <br /> Driller:_ 1 ov�i uz� a aY v casing <br /> height <br /> Consultant � Il 32" <br /> {��v,v�wnmaw�x.-Tox�rw�o¢ies G'n^,P� ThG , <br /> Geologist <br /> ABOVE-GROUND C _SIM-BOX <br /> COMPLETION COMPLEnoN <br /> SPECIAL PERMIT INFO. Swtacs <br /> Distance to sewer line f} grout <br /> Domestic well on site - (y ACA-) 35 n <br /> If yes, location and distance - <br /> ft. <br /> .fin. <br /> m <br /> — o <br /> — c <br /> — o <br /> SAMPLING slotted _ S <br /> wc5on — <br /> Holding Temperature <br /> Method <!Nve , t,t v"J Z. total- bsymk <br /> Screening Method -ib <br /> Tracking Sheet - y/ n ) <br /> tt. <br /> SPOILS <br /> Storage Method c5 h s,-#, Vb LI -oO 6, MATERIALS/DWIELOPMENT <br /> Contamination Noted - /n) 00 <br /> Storage Location vw Casingtype 2" Sckelu(e qtr Nr– <br /> Blank j—ft. Screen Ill ft. <br /> Slot size O,olo – xJ <br /> GROUTING Bags cement F +q i6 <br /> Buckets bentonite_ 50 _ <br /> Depth to water Bags sand/gravel 9 So b <br /> Mix Ratios 34 <br /> s S :lA.v s Filter Pack type/size Man lcergV +#z <br /> Installation Method a.v�rr ry r Surge <br /> u ge Block: <br /> with ge7/ogist: - (( n} <br /> Quantity Installed ��u<•&hs <br /> Type of method Sw.aa�r��V'Vg b.Q P:nnT <br /> EH 29 29 <br />