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p a..h.. i1/a 5I9`f� <br /> ti <br /> MONITORING WELL INSTALLATION REPORT <br /> 0 cc <br /> ,� 0 w CONSTRUCTTON � � <br /> Date: Ir�����r _ <���- y:� ! / .� - � I <br /> ( <br /> Premise Address: 3LI37- A, �+.��'� Total Depth <br /> Screen Length (from) Co 5" (to) YS"� <br /> Filter Pack (from) � <br /> Well No.: t4,1 <br /> Bentonite (from) ti 3 ` (to) Y/ <br /> Inspector: 0Z__ - Grout (from) <br /> Drilling rig typed.y �r <br /> Permit No. - - Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: y <br /> �,�� _ casing <br /> Driller: <br /> p height <br /> Consultant ! s <br /> Geologist A P71 Z4 Alt, -- Ajj;VE-GRCUND <br /> CCNAlSTY-80X <br /> OMPIETfON <br /> COMPLEMN <br /> SPECIAL PERMIT INFO. around Surface <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - ( y/ n ) ft. <br /> If yes, location and distance - ft. <br /> ft. <br /> SAMPLING (� - S a ` o `"c` ' S` olor.ei <br /> sucicn <br /> Holding Temperature��� ` _ <br /> Cr'iY9�F.3'* <br /> Method <br /> Screening Me od <br /> Tracking Shcet - (T/ n) ' _ <br /> f2. <br /> SPOILS i <br /> Storage Method ""/"� `' !``—" MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/fin' Casing type q/` /n`C 5 C_� <br /> Storage Location 6 <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite l -' <br /> Depth to water V S Bags sand/gravel <br /> Mix Ratios Filter Pack type/size o� �� <br /> Installation Method curge Block: - ( y <br /> Quantity Installed rad S� Discussed with geologist: - (y/ n ) n <br /> Type of method tee <br /> EH 29 29 <br />