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• • <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: I Z z I Q(`) CONSTRUCTION <br /> Premise Address: nn.Q n_ Total Depth JO <br /> Screen Length (from)_1,0 (to) (O <br /> Well No.: VWltil zl Filter Pack (from)_�_(to) Y0 t <br /> Bentonite (from) S (to) R <br /> Inspector. Grout (from) (to) "7-1 <br /> Drilling rig type <br /> Permit No. O U Z Auger O.D. I.D. <br /> �� Completion . Stove pipe/ tris a ox (circle one) <br /> Drilling Company LnJ�J1-at; l a <br /> ill <br /> Drer: ;?--DlVv1 O casing <br /> height <br /> Consultant <br /> Geologist <br /> ABCVE-GACUND C SZ Y-30X <br /> COMPLEr1CN COMPLEnON <br /> SPECIAL PERMIT INFO. Ground SLrlact <br /> Distance to sewer line grout <br /> Domestic well on site - ( y/ n ) 1 S (t <br /> If yes, location and distance - tt <br /> _ a <br /> = m <br /> — o <br /> SAMPLING �lota7 <br /> sac'on — <br /> Holding Temperature e-n^ t i gnvd Pack <br /> Method _ <br /> Screening . ethod PI ii <br /> Tracking Sheet - 10)/ n ) <br /> --ILLtt. = C) f1. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted • n ) n PU <br /> Storage Location otn g� �rY Casing type <br /> Blank I b ft. Screen 30 fr. <br /> Slot size oZ d <br /> GROUTING Bags cement " -2— <br /> Buckets bcntonite�l <br /> Depth to water /\-/Z*6 Bags sand/gravcl I y <br /> Mix Rados 16, <br /> R zD Filter Pack type/size 1i' ixoin <br /> Installation Metho Surge Block: -Mn ) <br /> Quantity Installed k0 Discussed with cologist: . (y C9 <br /> Type of method <br /> EH 29 29 <br />