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MONITORING WELL INSTALLATION REPORT <br /> Date: J 2ur --70t2 CONSTRUCTION <br /> Premise Address: 3915 N BNX DY�k S-4- QA Total Depth %a <br /> Screen Length (from) 92 (to) 4� <br /> Well No.: TOAZ -St Filter Pack (from) —4 (to) 9n <br /> Bentonite (from) (to)�� <br /> Inspector: —LeA —1 Grout (from) 1 (to) je, <br /> Drilling rig type C tAg 95 <br /> Permit No. 0O 61S,201 Auger O.D._ I.D. <br /> -Move pipe • 4 4'� <br /> Completion - stle box Ccircle one) <br /> Drilling Company: <br /> Driller: -Foye z✓ casing <br /> // � ((11 �I hei <br /> ` ght <br /> Consultant T8 viywb"rY\e"`IclL 7�ryolyjits CS.Yv.��� '-. 30 4 <br /> —EWT <br /> Geologist �A%e <br /> ABOVE-GROUND CHRLStt-BOX <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Sulx 7— <br /> Distance to sewer line 30'0 grout <br /> Domestic well on site - (y n <br /> If yes, location and distance - ft• <br /> m <br /> D <br /> SAMPLING abnad <br /> sac5on <br /> Holding Temperature 4-o G <br /> gmyW pack <br /> Method Iv,rd. rY sen✓ — Z.9 49+ <br /> Screening Method iD <br /> Tracking Sheet - ( 'n ) <br /> qD ft. - ft. <br /> SPOILS <br /> Storage Method 0 w roll- ' MATERIALS/DEVELOPMENT <br /> Contamination Noted - /n) r� <br /> Storage Location v%A,.-1•L. c4. rhr &,'lt Casingtype a" SC/LwJU - a9 WC- <br /> Blank 'to ft. Screen Ib ft. <br /> Slot size I' - +til, <br /> GROUTING Bags cement ZX- V 1 <br /> Buckets bentonite 1 50 Ito <br /> Depth to water 4 " Bags sand/gravel Vb.5 --:�0 1 <br /> Mix Ratios C44AL 5 ;a Filter Pack type/size nvr} vvni *-2 4k <br /> Installation Method aAU v i*,_,,,_,,,,,_ Surge Block: - a/ n ) <br /> Quantity Installed o Discussed with geologist: - Q)/ n) <br /> Type of method SN4e Q svgs z�.6nnr- <br /> EH 29 29 <br />