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*MONITORING WELL INSTALLATION RET n� <br /> ` p V� �QQs rtir� l sa�rv� ��y „ss <br /> Date: � / ]� I CONSTRU NS w ' GJ �z' SV39 `w <br /> Premise Address:4 2 V altA- ut/� Total Depth 32 7 3 8 3g 38 <br /> ', 1 Screen Length (from) 3 g (to) ' <br /> Well No.: - Ct ZZ VW" L' Filter Pack (from) 79 (to) -f <br /> O A 1 /' Bentonite (from) 3'i- (to) 37 <br /> Inspector: /v C 74f3� Grout (from) �Z (to) o <br /> Drilling rig type <br /> Permit No. S(ru. 25-5 Auger O.D. 12y I.D. , <br /> A/1 .5 3 Completion - Stove pip 'stie box (circle one) <br /> Drilling Company: /_ l <br /> Driller: � ' � 3- I casing <br /> J <br /> n G".4 1 -0 T height <br /> Consultant �-{ n� T <br /> Geologist teA)1!ti /0 6— _ T <br /> /180VE-GAOUND CHAIM-80X <br /> COAPLF'fbN COMPLErCN <br /> SPECIAL PERMIT INFO. Ground Surtan <br /> Distance to sewer line at <br /> out <br /> Domestic well on site • (y/(-a) � <br /> If yes, location and distance - <br /> tt. <br /> tt. <br /> r <br /> e <br /> n p = <br /> SAMPLING sbttad _ c <br /> \'OC- sac9on <br /> Holding Temperature <br /> Method = Pack <br /> Screening Method — <br /> Tracking Sheet - ( yin ) _ <br /> SPOILS / <br /> Storage Method Y� Slkp Off` MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n j -A <br /> Storage Location Casing type <br /> Blank ft. Screen ft <br /> Slot size - <br /> GROUTING Ma Bags cement <br /> Buckets bentonite <br /> Depth to water -76 S JO Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method '-r Surge Block: - n ) <br /> Quantity Installed Discussed with ologist: - y/ n ) <br /> f=11 i , sw- g VVj-4 5 -7-3 -. Type of method <br /> EH 29 29 / <br /> 20 <br /> ao �p <br />