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..w <br />�r7ic <br />i4.�NITORING WELL INSTALLATION REPOR� <br />Date -61 / V-ls Rl - <br />Premise Address:—/ Z Y 9— <br />Weil No.: / -, 2'1 3 <br />Inspector: <br />Permit No. ��' ry7F <br />Drilling Company: <br />Driller: <br />Consultant W, iJ <br />Geologist <br />SPECIAL PERMIT INFO. <br />Distance to sewer line t44 <br />Domestic well on site - ( y n <br />If yes, location and distance - <br />SAMPLING <br />Holding Temperature aC/ <br />Method q5!A i✓ <br />Screening Method J= <br />Tracking Sheet -Uy <br />y- n ) <br />SPOILS <br />Storage Method e <br />Contamination Noted -y n ) <br />Storage Location <br />GROUTING <br />Depth to water O d <br />Mix Ratios G�/bupizu <br />Installation Method <br />Quantity Installed G.> <br />CONSTRUCTION <br />Total Depth '70 <br />Screen Length (from) 0' (to) 737, <br />Filter Pack (from) (to)3? ' - <br />Bentonite (from) '73 (to) <br />Grout (from) ::2(7 (to) <br />Drilling rig type S� <br />Auger O.D. & % " T.D. <br />Completion - Stove pipe/christie box (circle one) <br />casing <br />Theight <br />Ai&E4ROUND <br />COMPLETION _. <br />COMPLETION <br />Ground Surf we <br />ft. <br />816tted <br />aacaon <br />MATERIALS/DEVELOPMENT <br />tI Pack <br />Casing type 7— ei�GIC/ <br />Blank -2 -5 --ft. Screen ft. <br />Slot size .02,0 <br />Bags cement I b S �- <br />Buckets bentonite <br />Bags sand/gravel <br />Filter Pack type/siz �2 <br />Surge Block: - ( y/ <br />Discussed with ge ogist: DYU) <br />Type of method <br />