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.� MONITORING WELL INSTALLATION RE,.,.,,T <br /> Date: ` CONSTRUCUON <br /> Premise Address: jaqoj rA Total Depth,_,__ <br /> Screen Length (from) D (to) <br /> Well No.: M W 3 oun k-v- S+. Filter Pack (from} (to) <br /> M ��`j�l� Bentonite (from) (to) <br /> Inspector: Grout (from). 4� _--(to)�� <br /> Drilling rig type CEM_ 24 Zq <br /> Permit No. L CLl C + 1 Auger O.D. Vr I.D. <br /> Completion - Stove pipe c iris[ie a (circle one) <br /> Drilling Company: <br /> `f o rot E'4ar 5 <br /> ng <br /> Driller: o height <br /> height <br /> Consultantb tt 1 V <br /> Geologists <br /> ABOVE-GRMND C IRMTY43OX <br /> COMPI L7ZN COMPL=nCN <br /> SPECIAL PERMIT INFO. Ccound 8udxs <br /> Distance to sewer line grout <br /> Domestic well on site - ( y n ) ft. <br /> If yes, location and distance - - <br /> i A <br /> 3 Xt <br /> Q <br /> SAMPLING xlarn.3 = <br /> socicn — <br /> Holding Temperature H VzVW pack <br /> Method iM C 05 LLA- <br /> Screening <br /> Screening Method F2 <br /> Tracking Sheet - ( y/ n ) <br /> SPOILS <br /> Storage Method US LNJ SI;Y'V t t 55-7 MATERIALS/DEVELOPMENT <br /> Contamination Noted - {y/ n <br /> Storage Location vtd� Casing type 2� pvc <br /> Blank ft. Screen_ <br /> Slot size a <br /> GROUTING Bags cement <br /> Buckets bentonite 1 <br /> Depth to coater Bags sand/graveI, 4Yl- <br /> Mix Ratios 510 1 Filter Pack type/size <br /> Installation Method r[ Surge Block: - (0/ n } <br /> Quantity Installed Z- 1'..74 V I Discussed with geologist: - / n ) <br /> Type of method_ 2" blbcl-- _-- <br /> EH 29 29 <br />