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MONITORING WELL INSTALLATION REPOn f <br /> Date: J�'t` L `` y��/� r5� `�/_ Q�^ CONSTRUCTION <br /> Premise Address: Ya 41icwv 4`--"L_ Total Depth <br /> / � 1 Screen Length (from) (to) <br /> Well No.: � Filter Pack (from) (to)___`Q� <br /> Bentonite (from) 1" (to) 7 <br /> Inspector: _ �� Grout (from) (to) O <br /> Drilling rig type a GMc� <br /> Permit No. Auger O.D. I.D. <br /> DA <br /> pipe/christie box ( cle one) <br /> Drilling Company: <br /> Driller: sing <br /> fightConsultantGeologist ", ;404r C4-A15iY-B0X <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Crwnd Surface <br /> Distance to server line grout r of <br /> Domestic well on site - On ) <br /> n ) <br /> If yes, location and distance - <br /> ft. <br /> • $0 ft. <br /> SAMPLING elol _ B <br /> `/ , urian Nz <br /> — <br /> Holding Temperature /L4B� U ?Ylt..¢�r� <br /> Method 71W Pack <br /> Screening Method = <br /> Tracking Sheet ( y/ n ) <br /> ft. IF = tt. <br /> SPOILS <br /> Storage Method UW–e MATERIALS/l?EVELOPMENT <br /> Contamination Noted - y/ n )),,�/ <br /> �. /KO Casing type <br /> Blank ft. Screen_ 20 ft. <br /> Slot size 0X0 <br /> GROUTING Bags cement X-1 <br /> r Buckets bentonite <br /> Depth to water 6 Bags sand/gravel e. <br /> Mix Ratios )m Filter Pack type/size <br /> Installation Metho hW Surge Block: - (yCD <br /> Quantity Installed Discussed with geologist: - (y/n ) <br /> Type of method <br /> EH 29 29 <br />