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190NITORING WELL INSTALLATION R.EPORf <br /> Date: CONSTRUCTION <br /> Premise Address: "AA. Total Depth <br /> Screen Length (from) Icl k (to)_,� <br /> Well No.: A (aFilter Pack (from) A t (to) L(]_ <br /> Bentonite (from) S (to) � ' <br /> Inspector. Grout (from) -e (to) S , <br /> Drilling rig type <br /> Permit No. 0 0 2'Z '6 2- Auger O.D. <br /> ( ot Completion - Stove pip u istie box (circle one) <br /> Drilling Company: HJT <br /> Driller: 7Z Gt caeinq <br /> height <br /> Consultant <br /> 71 -E <br /> Geologist -F <br /> ABOVE GACUND C7-S*'TY-80X <br /> CCMPLFr CN COMPLETION <br /> SPECIAL PERMIT INFO. Ground Sulact <br /> Distance to sewer line gram <br /> Domestic well on site - y/ n ) <br /> If yes, location and stance - tt. <br /> a <br /> = m <br /> a <br /> = c <br /> o <br /> SAMPLING alorai _ 8 <br /> sac on <br /> Holding Temperature _ pavdpacx <br /> Method 5o e7* <br /> Screening . ethod I) <br /> Tracking Shcet - n ) is <br /> SPOILS <br /> Storage Method CSL p � . MATERIALS/DEVELOPMENT <br /> Contamination Noted • W n ) L w <br /> Storage Location 0-,\ 5�Lr Casing type <br /> Blank 'N,01Ch Screen <br /> Slot size o O <br /> GROUTING Bags cement <br /> Z6 I Buckets bcntonite_f Twp <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size -A:V?, S,a-o <br /> Installation Method ,pa, Surge Block: - 0Y n ) <br /> Quantity Installed —r— Z Discussed with geologist: -CYY n ) <br /> Type of method <br /> EH 29 29 <br /> �IZI�o� � �� I • <br />