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r i <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: -7-1— CONSTRUCTION <br /> Premise Address: 3015Nasi (�rn<,� 5lo�v ICA Total Depth �4✓ <br /> Screen Length (from) 3. (to) <br /> Well No.: 16/1z-y5 Filter Pack (from) ZM, (to) <br /> Bentonite (from) 2s (to) <br /> Inspector: .Grout (from) 6 (to) 24 <br /> Drilling rig type Craws 9-5 <br /> Permit No. ©065201 Auger O.D. I.D. J•1'ry." <br /> T—� Completion-Stove pip christie box (circle one) <br /> Drilling Company: C a3<,r a Vre 6hik I 1 p• <br /> Driller: �ir�. Sawa✓ w casing <br /> 38 height <br /> ConsultantyVL�VUwm�...�c�wolnz� Cwo,�-�'�u 33 " <br /> GeologistABOVE-GROUND CtiR751Y-BOX <br /> COWLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line -AOD grout <br /> Domestic well on site - (y/ L5 ft, <br /> If yes, location and distance - <br /> ft. <br /> _fin. <br /> C <br /> SAMPLING N6� ebtmd <br /> sacdon <br /> Holding Temperature <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/n) <br /> tL <br /> SPOILS <br /> Storage Method )oL(_•-aRZ �nve. MATERIALS/DEVELOPMENT <br /> Contamination Noted- (Cyy n) <br /> Storage Location no, ),L- s iA, Q i'-njQv4�' Casing type -2 4,0 P"'- <br /> Blank "3o ft. Screen S ft. <br /> Slot size O.Ot O-•w L <br /> GROUTING Bags cement 9 4'+ 16 <br /> Buckets bentonite "54 5D 16 <br /> Depth to water 4 Bags sand/gravel G 5'0 b <br /> Mix Ratios Filter Pack type/size IAD .A-e w., <br /> Installation Method a+..ro�M we Surge Block: - (�'y)/ nn <br /> Quantity Installed v,1Am'X _ Discussed with geologist: - U/ n) <br /> Type of method_ S r^"k vig <br /> EH 29 29 <br />