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0 0 <br /> MONITORING WELL INSTALLATION REPORT <br /> CONSTRUCTION <br /> Date: <br /> Premise Address: 3 Y (to) <br /> 3-7 S' A p� Total Depth frFl S <br /> Screen Length (from) 78 " 8& " <br /> Filter Pack (from) b'8 2- (to) -761 <br /> Well No.: sn �� Tk3t- 4 Bentonite (from)___ 7� (to) 7/ <br /> 1/'/s (to) � <br /> Inspector: Grout (fro ` <br /> Drilling rig type <br /> Auger O.D. I,--` Y-5/( <br /> I.D. <br /> Permit No. Completion- Stove pipe/christie box (circle one) <br /> Drilling Company. <br /> casing <br /> Driller: ��v s / <br /> height <br /> Consultant �c��.z c r� J o s A'''�� <br /> j <br /> g; s1 v- r. ABOVE-GRCUNO C}-Gz Y-8CX <br /> Cvtv4"�lON �=i'IC <br /> Gt'octnd Sue-act <br /> SPECIAL PERMIIT INFO. <br /> 0r= <br /> Distance to sewer line <br /> Domestic well or. site - (y n ) G - ft' <br /> If yes, location and dist ce - <br /> o <br /> SAMPLING sacton72 <br /> - <br /> Holding Temperature <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ <br /> n <br /> SPOILS <br /> MATERIALS/DEVELOPMENT <br /> Storage Method <br /> Contamination Noted - (y/CO Casing type <br /> Storage Location /^ ��� f "' ` '�"` `' Blank '70 fL Screen /a ft. <br /> Slot size <br /> Bags cement <br /> GROUTING Buckets bentonite f <br /> SO Bags sand/gravel 4� ov/7r <br /> Depth to water _ Filter Pack typesize <br /> Mix Ratios �"lu r ,,��,t, �.�,cL �:�-,`�' <br /> Installation Method >��^^—{-0 -Surge Block: - C(3)/ n ) <br /> n <br /> Quantity Installed '`� '� _ ^y" Discussed with geologist. ) <br /> Type of method r 9 <br /> EH i 29 29 <br />