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I <br /> MONITORING WELL INSTALLATION REPORT � ~ <br /> • a <br /> Date:_ CONSTRUCTION <br /> . Vii. c _ <br /> Premise Address: IS 2 Jeyy,Tci�VG T Total Depth 3,S Fed- <br /> ('s- ' <br /> Well No.: _ - Screen Length (fiom)_ IS-Fe (to)� FFilter Pack from)f (to) <br /> Inspector. G entonite (from) (to) <br /> / <br /> SFeof f( <br /> GrouC ) <br /> (from _ I D <br /> r (to)_So ✓ �r <br /> oa 3 7782 Drilling rig typeaCeess r' <br /> Permit No. Auger O.D. �[ 1 <br /> /.�S i <br /> - <br /> Completion - Srove pipe/ tristie box (circle one) <br /> Drilling Company: 17-rem a r rZ) � ) ,"h <br /> Driller: Jv-reri, Neff - f PP W py casing <br /> t�OC VB•-11a1SGo — RSSiS 9 7^c�L7 r���FiY �� height - . . <br /> .Consultant CJym br• 6- <br /> n <br /> Geologist A <br /> JIP.OVE•GRCUND ` <br /> CONVLENGNCHRSLY-Box <br /> SPECIAL PERMIT INFO CoNtPL•TICN <br /> Ground Ststxe <br /> Distance to sewer line �k { ��F�� �rayyYlyW-S ara t . <br /> Domestic well on site - (y/(E0 <br /> If yes, location and distance - <br /> _ k <br /> SAMPLING - = o <br /> 1 // alon,ri c <br /> Holding Temperature (�`}� g j �- ✓IDt nyU ('}r ' <br /> Method_ /o ;-a« <br /> Screening Method p ).D <br /> Tracking Sheet - (Y/ n )Sh <br /> uAS <br /> 3S ft. <br /> SPOILS <br /> k <br /> Storage Method CoY V' MATERIALS/DEVELOPMENT <br /> Contamination Noted - (;A n 1!r <br /> Storage Location_ mL -S i-t-i i Casingtype-- 3&& edvl� 40 <br /> } Blank' - IS ' fr.° z Screen ' 20 ? ft. <br /> GROUTING \ .;a Slot size l , D 0 <br /> . .: -�� 3 Bags cement <br /> / Eec- ),5bcntonire hs <br /> Depth to water :'0 4 .b roJ1 S'ur7z{ .Bags sand/gravel 'v or eco <br /> Mix Rados /' ga// „r 1/ao h l -9r! bporfl Filter Pack type/size �y lrr /�ta1e i <br /> -installation Metho 1 r o ��,1,/ 1 b''�eP 10 e - Surge Block: - (y ti rLP}s -Lustre•s� <br /> Quantiryinstalled_- 3, S = a lb • b�r`l. ¢r. ,Discussed with geologist: - ®/n) f <br /> 4'#" 'Type"ofinedtod_ Cnn'1 ' use :5 <br /> EH 29 29 <br />