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MONITORING WELL INSTALLATION RW'--' <br /> Date: C'+o Joe'v )O :Z 0 0. CONSTRUCTION <br /> Premise Address: 6 .3z- )4L.) 4 Total Depth_ .3c/,5 <br /> Screen Length (from) 3 q,S (to) if,6 ' <br /> Well No.: M W ) U l Filter Pack (from) _ (to) 7.G ' <br /> Bentonite (from) 176 (to) <br /> Inspector: Grout (from) %�, ` (to) so r 40 <br /> P� 6� �, f�,,/ Drilling rig type Ir ' Ts- <br /> Permit No. `7 Auger O.D. n I.D. Z5- <br /> Completion <br /> SCompletion - Stove pipe/christie box (circle one) <br /> Drilling Company: .54, � - <br /> Driller: Je 1 11- casing <br /> ss is lJV/1 <br /> yy ✓ - 610 �}rno� j ?�jzQPGs,� height <br /> Consultant 'r rt m A <br /> 17 <br /> Geologist C y r e ne- <br /> MOVE-GROUND <br /> COMPLETION CHRMTY43OX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. pend Surf&:* <br /> Distance to sewer line V 1 grout <br /> Domestic well on site - y/ n) n <br /> If yes, location and distance <br /> 300 Temp W e$+- <br /> = m <br /> SAMPLING = ° <br /> slatted <br /> Holding Temperature <br /> Method dJ >� - gs"eI Pack <br /> Screening Method X — <br /> Tracking Sheet y n ) � <br /> .X <br /> � 11. <br /> SPOILS <br /> Storage MethodMATERIALS/DEVELOPMENT <br /> Contamination Noted - (y A9 <br /> Storage Location O Yl- 51+0- Casing type So,h G DCy b <br /> Blank .20 ft. Screen .2 b ft. <br /> Slot size 0 -020`' <br /> GROUTING Bags cement io 4os <br /> ` <br /> Bulk& bentonite_ 50-1b bfie -u� ." 15, <br /> c Ic� <br /> Depth to water .27- 3D Bags sand/gravel —� / L4 <br /> Mix Ratios z v Filter Pack type/size # 3 try <br /> Installation Method Surge Block: - (y <br /> Quantity Installed Discussed with geologist: - 0/ n ) <br /> Type of method_ j <br /> EH 29 29 <br /> Groff U,54,4 rigsf 3�, con�� <br /> No ma r k o,t '15 �Po r�)a,�T�� r�� � �Lo, n a� i yL <br /> S�okc. �-i rn k .>✓h�Yev, - rn;)Z- 4-Y14 i,r +!ko6 A Q4� _ <br /> -2- Po,+ ;J a <br />