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MONITORING WELL INSTALLATION REr-T <br /> Date: " U D bP— I d ZOO 5 CONSTRUCTION <br /> Premise Address: P&jc 4 q9 o y L Total Depth_ 31V <br /> Screen Length (from) 3R (to) i <br /> Well No.: i o L Filter Pack (from) S (to) <br /> 1 / , Bentonite (from) `- ) ' <br /> Inspector: V+ 1: 0��(7//Lt ��ia3 Grout (from) (to) <br /> Drilling rig type - <br /> Permit No. f9 6 S 615 r7 l Auger O.D. R ', „, �i I.D. q).),- j&JA 4,,)' <br /> 9 <br /> Drilling Completion - Stove pipe/christie box (circle one) <br /> Driller: JOT <br /> � r � <br /> Ua r-"re-rn , casing <br /> J 'a"­s — of oL” 1 cj. iOJf raw �y height <br /> Consultant �d��o V j ILI n te r,(' <br /> Geologist- reina' -- <br /> ABOVE-GROUND <br /> COMPLETION C8AISrY-80X <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line grout <br /> Domestic well on site - n) <br /> If yes, location and distance - . <br /> SAMPLING = o <br /> sbttad <br /> Holding Temperature <br /> Method N A- <br /> �"�P <br /> Screening Method <br /> Tracking Sheet - (y n4. <br /> ) <br /> tt, <br /> ft. <br /> SPOILS <br /> Storage Method �r��C'�D,�l P MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/� J <br /> Storage Location otii r f C Casing type SC be L�✓ie- 40 <br /> Blank----j.5 ft. Screen <br /> Slot size 0 0�2 0 b <br /> GROUTING Bags cement <br /> c;) Buckexs bentonite - _J,,( -.)IV �'vr��2 uts <br /> Depth to water 1 3l) Bags sand/gravel V,5 111�i l-, �t�Lc1,o;S <br /> Mix Ratios Filter Pack type/size 43 LJst'e <br /> Installation Method / Surge Block: - (y/0 <br /> Quantity Installed Discussed with geologist: - (q/ n ) <br /> Type of <br /> EH 29 29 �� k�r f o r 6ti. ew /J2�� /Qr.4j�n2 V)(Le, 10 dl plc I 0 i <br /> 6f)"4 �I -'n 41 6 ax,,,4 h a4 V <br /> r <br /> �b 4 Qat 41,,, 4vAd1 <br />