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MONITORING WELL INSTALLATION REPORT <br /> Date: �� CONSTRUCTION <br /> .ye ���7 9vo_ /Aw"os <br /> Premise Address:_ /!4 772 4 <br /> ,fi4 609 Total Depth 90 <br /> Screen Length (from)• 70' (to) 8S1 <br /> Well No.: Jdr►/.?3 -90 Filtet Pack (from) G$ (to) ya-1 <br /> „/ Bentonite' (from) l6S' (to) dote j <br /> Inspector: Jb � Grout (from) O ' (to) 66'� <br /> Drilling rig type l of ,r ,O,Gimy DV .vim <br /> Permit No. Auger O.D._ 6:�&" I.D. <br /> Drilling Company:—&Zf&,6_ p,2,�G/,✓j_ Completion- chnstie box (circle one, <br /> Driller: <br /> casing <br /> height <br /> Consultant <br /> Geologist (2 rIneJ eoxy j .' <br /> AZO VE-G A OUND <br /> CO},FLE ION CHRZ Y-$OX <br /> MI <br /> SPECIAL PERT INFO COMPLETION <br /> Ground Surfxa <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n) 6S <br /> If yes, location and distance - - h. <br /> . <br /> 70 <br /> " � 0 <br /> SAMPLING = o <br /> Ila <br /> Holding Temperature �✓�I = <br /> Method niq = ;rav;4 pacts <br /> Screening Method A✓h- <br /> Tracking Sheet - Cy/n) /P4, <br /> tt. <br /> SPOILS r <br /> Storage Method Lo✓PfCP.9 Rp py` 6dX MATERIALS/DEVELOPMENT <br /> Contamination Noted - /n) <br /> Storage LocationCp,✓� ,o �s�oNa y Casing type 5S�,Y & pvC- <br /> Blank 7P ' ft. Screen �S ' ft. <br /> GROUTING Slot size_ oloze� <br /> Bags cement <br /> Buckets bentonite <br /> Depth to � 2 <br /> water Nn� <br /> ti <br /> Mix RaBags sand/gravel_ . (os Filter Pack type/size ' '5 <br /> Installation Method_ <br /> Quantity Installed Discussed with geologist: -6?/ n ) <br /> EH 29 29 Type of method <br />