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,-.eONITORING WELL INSTALLATION REPO <br /> Date: N P'19 I l [ C— CONSTRUCTION <br /> A' � <br /> Premise Address: gy p_S Nag� 1�yA uq Total Depth 3b <br /> Screen Length (from) 3D' (to) In, <br /> Well No.: I ICU Filter Pack (from) (to) ' <br /> Bentonite (from) (to) <br /> Inspector _ thY al Grout (from) (to) <br /> Drilling rig type <br /> PermitNo.— Auger O.D. U <br /> Completion - Stove pipe/ sae bo: (circ a ne) <br /> DrillingCom��pa1n`y:,, �n jj Pin <br /> ��� <br /> Drillerlr���lUt`I�[JV1�S� tKt Pin IA;rdo casing <br /> J— height <br /> Consultant aOhnG �SN1 3&7T <br /> Geologist Tom L A+PVVV\a n Q�nf/ -tw' <br /> ABOVE-GROUND CHA7STY480X • <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO, G=nd SuAan <br /> Distance to sewline vj n Ori <br /> Domestic well oner site ,Orooh 5 <br /> If yes, location and dis cft. <br /> CciQ Ct)111 <br /> �F0(Wti <br /> Rfll7ro>L `�Dl N 0f MW(' rerT S <br /> _ o <br /> SAMPLING Y = <br /> g <br /> alot:ai _ <br /> �r axicn <br /> Holding Temperature 'Y <br /> Method QA 0 kg Ito <br /> Screening M thod •P <br /> Tracking Sheet - y n ) _ <br /> i <br /> SPOILS <br /> Storage MethodAn 065hr, MATERIALS/DEVELOPMENT <br /> Contamination Noted -- n ) ^t( PSC= <br /> Storage Location /if ih Casing type oC <br /> T Blank IU ft. Screen W' ft. <br /> Slot size .O I'D <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios C Filter Pack type/size f <br /> Installation Method WY Surge Block: - ( y i <br /> Quantity Installed Discussed with geo tst: • (�/ ) <br /> Q�G a( 'EH 29 29 Ci, .•.,, eY Type of method t <br />