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ONITORiNG WELL INSTALLATION REPL <br /> • r <br /> Date: C0 l CONSTRUCTION <br /> Premise Address:--?`� ? Rk�_tfi� Total Depth `T J <br /> �n q Screen Length (from) (to) <br /> Well No.: �`l� 1 Filter Pack (from) (to) 7.--'; <br /> Bentonite (from) • _�3 (to) ZD <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: llrLtlnetk yr iyaffs <br /> Driller: D [ - cas Ing <br /> ,�,�(�] IMT <br /> he Consultant_�&Jc V1CP� G`e-O Erwwz �� u�^=' <br /> Geologist �_1M C.t1V LICU1. �1� Q _�J Pte' <br /> VA <br /> ABOVE-GROUND <br /> COMPLETION CF4FitSTY 3OX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Grouhd Surface <br /> © rout <br /> Distance to sewer lined �.� <br /> Domestic well on site - (y/ n 2p . <br /> if yes, location and distance - 25 _ <br /> i 1+. <br /> o <br /> SAMPLING slatted <br /> svc5on #• —_ <br /> Holding Tempt Q w:. Gni pack <br /> Method ' ` <br /> Screening Method <br /> Tracking Sheet - n) <br /> SPOILS - rte: Pier-$ We.A-0- no k GteGdr r <br /> Storage Method,T�- MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ <br /> Storage Location �� Casing type <br /> Blank 2 ft. Screen -9--o <br /> Slot size - D 'b <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel�snus'*8. EnMeon &w-rt imW_ <br /> Mix Ratios f Filter Pack type/s e <br /> Installation Method Surge Block: - ( n ) <br /> Quantity Installed Discussed with geolI 'st: - / n ) <br /> Type of method <br /> EH 29 29 <br /> iv Uv A gbbV cd tb L65kg U/Av -&tyW bU+ hi <br /> Deeded no+ -to d.-cq to st�¢wc�ik swucC �o� wove eCk ` ©ir 4f�c- Dr�11ed t+� 44 s�% ' <br />