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. ,NITORING WELL INSTALLATION REPOI\ <br /> Date: 2D0 7 CONSTRUCTION <br /> Premise Address: Sr, `Y'1e_ Shaddg_i- a St, Total Depth 38, S fee,+- <br /> Screen Length (from) 38 ' (to) ZS <br /> Well No.: L(J `.Z S Filter Pack (from) 3S. S (to) -25,T � <br /> Bentonite (from) -?S.S ' (to) 2.3 ' <br /> Inspector- �j��.� Wg Za r Grout (from) 23 ' (to) r <br /> Drilling rig type 'r f at .-q ` 7"r sc rern <br /> Permit No. .Z2 Auger O.D. A) AH <br /> Completion - stove pipe CTC box (circle one) <br /> Drilling Company: �PJ'f'A»���-%cam <br /> Driller: ;ek 4OJ'SCh �IirG �I.p'JJf:��7Ls c, q.t casing <br /> Kee height <br /> Consultant <br /> Geologist lea h r) Ir -- <br /> ABC VE-GR CUNO CHRZTY-BOX <br /> CO kV L.ETC N <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line on Lo_/)-,j r. grout <br /> Domestic well on site - ( y/(n S-'re-z f' .2-3 <br /> If yes, location and distance - ft- <br /> _- <br /> v 6 Oc1t�i rt c <br /> SAMPLING <br /> tac�cn <br /> HoldingTem erature p,J F} �shg) a. _ <br /> Method P Sidtukilk CSa0 J;A7 S eef = pavelpacSc <br /> Screening Method <br /> C <br /> Tracking Sheet - ( y/ n ) <br /> ft. <br /> SPOILS / 1 <br /> Storage Method f} - t�se- ! r /-D a r MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) LL <br /> Storage Location Casing type ��ll..��7�✓ <br /> Blank Z ft. Screen /O ft. <br /> Slot size 0. 010 ' <br /> GROUTING Bags cement S b,�4.t - 95- l,Seg A*ig, F, �fq <br /> BuCICCtS bCntvi2ite iz r u.- b -S.1,74 �---f <br /> Depth to water ^'2 SJ Pags sand/gravel r # 30 <br /> yr <br /> Mix R� 'r ci 9 loertI41VFilter Pack type/size -:2 / -L � <br /> Installation Method -frg o Surge Block: - 4)_/ n ) <br /> Quantity Installed m e L >`� Discussed with geologist: - a/ n ) <br /> Type of method Su rga- <br /> a r L <br /> EH 29 29 <br />