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MONITORING WELL INSTALLATION REPT . <br /> y <br /> M W 5 1 n5-tcc tLecj U' <br /> l AMP (a- <br /> Date: 4 CONSTRUCTION <br /> Premise Address: 1 2 �Q C Total Depth �5 <br /> Screen Length (from) 45 (to) 25 <br /> Well No.: "W <br /> Filter Pack (from) 45 (to) 273 <br /> I VM l Bentonite (from) 2.3 (to) 2 i <br /> Inspector: Grout (from) 2E (to) (� <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box a one) <br /> Drilling Company-.. M l .e Dv—,(�L� <br /> Driller: 1010 -jyn Lcasing <br /> n�,, ,�J s,,,( 1�--'ti height <br /> Consultant ��e.� ��w � <br /> Geologist_ 9�'dl�1 •- <br /> ABOVE-GROUND Cl•WIM-BOX <br /> �U La �'�V� --e�l- COWPLEfION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surfaco <br /> Distance to sewer line grout <br /> Domestic well an site - (y n MWS K �2 ft. <br /> if yes, location and distance - <br /> O p sl,+ ft. Z ft. <br /> No-v's 6.� 5obmc ao a s! 0 5'� o <br /> 9l1I d C14`f311{-.,� <br /> ! ..C.25'I"LJ p(1�+lt/•�-�C G,+}�, .• <br /> y d Is--us*ed[w riL�l✓1 <br /> SAMPLING T%le ��ac�tte. C11I. fIrIP405 �J� D s, 810ttad — <br /> aacson a <br /> Holding TemperaturetLnuLd ca vol p <br /> Method '� � pack <br /> Screening Method Mw5 _ <br /> Tracking Sheet - {y/ n ) <br /> F� 50nscy <br /> SPOILS �` k <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - {y/ n ) n 1! PVC i1 <br /> -T <br /> Storage Location_ 6 n S for— Casing type < <br /> Blank ft. Screen <br /> Slot size �Z <br /> GROUTING--- 1 VIN 2 '" Bags cement <br /> 7 Buckets bentonite <br /> Depth to water J� Bags sand/gravel <br /> Mix Ratios gowg Filter Pack type/size <br /> Installation Me od Pb v Y Surge Block: - (y/ <br /> Quantity Installed Discussed with geologist: - V n) <br /> Type of method <br /> EH 29 29 <br /> j� o 4y`-T�i vv\C.je t tan -t- Vg,\) 1 ft\-11,ab?7en <br /> w �d0aACed 6e-o&W, L W t-0 yrn155(fln <br /> gppro\fed K)bvl�' p�c�,�n t nb� i6b 5aMPEC50 Itj <br />