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✓ -„..JNITORING WELL INSTALLATION REPO <br /> Date•,__, �a 'il�I i' CONSTRUCTION <br /> Premise Address: 444-' �nS G1b LS� Afcf' Total Depth p <br /> Screen Length (from) 40 , (to) <br /> Well No.: M((” Filter Pack (from) (to)� <br /> SCJ JJQ C-7 lBentonite (from) (to) <br /> Inspector: y Grout (from) /lc (to) !!5,-- <br /> �/ " 31 S 2- Drilling rig type M G BHS P11 14.(- <br /> Permit No. Anger O.D. I.D. <br /> Drilling Company: ju <br /> Completion - Stove pipe/ stie boy (circle one) <br /> � /�(G�INGT, <br /> Driller: ? l7L casing <br /> � 1 height <br /> Consultant '4 <br /> Geologist Olt, .! ,el r' T <br /> ABOVE-GROUND <br /> COMPLETION CMM-Sox <br /> SPECIAL PERMIT INFO, Gmund gWwy <br /> Distance to sewer line grcut <br /> Domestic well on site - (y/n ) �__'_,__it. <br /> If yes, Iocation and distance - <br /> M <br /> V' O <br /> f�. d <br /> SAMPLING <br /> 1 — o <br /> �loroi y <br /> sodcn <br /> Holding Tempfrature <br /> Method r <br /> Screening Method :.rx <br /> Tracking Shcet - ( n ) t <br /> y 1�. <br /> �rlt. — <br /> SPOILS ,t, <br /> Storage Method � tx � MATERIALS EVELOPMENT <br /> Contamination Noted - f-/ n) <br /> Storage Location Casing type Q � �;&4 4d <br /> Blank 7 V0 ft. Screen k ft. <br /> Slot size O• a?-� <br /> GROUTING Bags cement <br /> i Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios SIX 3,n Avq l J Filter Pack type/size a �nr�S t <br /> Installation Method -X Surge Block: - (W n } <br /> Quantity Installed Discussed with geologist: - n) <br /> EH 29 29 Type of methodAuG Gt <br />