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MONITORING WELL INSTALLATION REr-- <br /> Date: 0 C'4d foz,^ j ( , LD 0 CONSTRUCTION <br /> Premise Address: 13 Z P tI Total Depth <br /> Screen Length (from) (to)_ .2,") " <br /> Well No.: OVl lti J n4-- Filter Pack (from) D ' (to) T <br /> Bentonite (from) /,9 ' (to) _ <br /> Inspector: V 1Grout (from) / (to) <br /> _ Drilling rig type_ �'� " <br /> z4 <br /> Permit No. �k D - 5 r f Auger O.D. I.D. , 2� ` <br /> Drilling Company: <br /> Completion - Stove pipe/christie box (circle one) <br /> r� �� i <br /> Driller: Je44 casing <br /> 4Ssls � S - 04r, o L/grrtc�'�` n�rCs✓ D11� height -- <br /> Consultant <br /> Geologist E rPinc_ �b SV e'-Yi ._ <br /> G 0 a – '10 e 7 ABOVE-GROUND X <br /> COMPLETION <br /> COMPLETION <br /> SPECIAL PERMIT INFO. pend Suriacs <br /> Distance to sewer line pout <br /> Domestic well on site - n) 1 /� ft• <br /> If yes, location and distance - <br /> C4 d2 ft. <br /> �• C <br /> SAMPLING = <br /> r sbttad � <br /> Holding Temperature- <br /> Method gmvw Pack�: — <br /> Screening Method dy <br /> Tracking Sheet - (y/n ) r, <br /> u ft, <br /> SPOILS <br /> Storage Method m MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/n <br /> Storage Location Sem Casing type_ <br /> o e -eW a-,.y`4-�w_ 10Qe,,of-yyj lc>16/ Blank_ o D ft. Screen 'L <br /> Slot size 0 - 0 <br /> GROUTING Bags cement <br /> Buckets bentoniteaXL <br /> lbrt <br /> Depth to water ,M 2S �I b S6 Bags sand/gravel <br /> Mix Ratios 4 j yz Filter Pack type/size <br /> Installation Method ab 0 Y, Surge Block: - (y <br /> Quantity Installed Discussed with geologist: V n ) <br /> Type of method <br /> EH 29 29 �e j�yrL I��i��p"y 0 e�Lf' �%v qj lLn� �v�Pir✓ clJ� ��✓�Y���r,�. <br /> mit � dr>vj-e �g'b��+z Qf�i���?�J'lP�� Vk <br />