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MONITORING WELL INSTALLATION REPORT <br /> Date: S�Z ; y CONSTRUCTION <br /> Premise Address:_ �pbt N , C4�i ,r,., ,�,, Total Depth `1 <br /> Screen Length (from)' 2,f (to) y S <br /> Well No.: � -(p Filter Pack (from) 7,(4 (to) <br /> Bentonite• (from) 1,0 (to) <br /> � <br /> Inspector: O Grout (from) Dt LT -(to)•Z_ <br /> Drilling rig type '1T <br /> Permit No. Auger O.D. W 2 37 LD <br /> A Completion - Stove pipe/ • stle box ( ' cle one) <br /> Drilling Company: %��I WEU CL4 j <br /> Drilled': ToQ _ U-C C'V . casing <br /> height <br /> Consultant Adomuced <br /> Geologist �a - V <br /> APC VE-G R CUND <br /> CC wLETC N CJ-iR ZTY_SCX <br /> COMPL_MCN <br /> SPECIAL PERMIT INFO. Ground SLzf <br /> �r r ()- <br /> Distance to sewer line J �rocrt <br /> Domestic well on site - (y/n) <br /> If yes, location and distance - 7, ft. <br /> 1 ft. <br /> ft. <br /> _= m <br /> SAMPLING — o <br /> Io Clad _ — c <br /> Z o <br /> Holding Temperatur <br /> 370 <br /> _— <br /> MethodI( Q / C = "'794 pa_'� <br /> Screening Method <br /> Tracking Sheet - /n = <br /> SPOILS <br /> Storage Method MATERLALS/DEVELOPMENT <br /> Contamination Noted - /n) - <br /> Storage Location oma! Casing type PVA <br /> Blank ZC ft. Screen Za ft. <br /> Slot size . 'V <br /> GROUTING Bags cement Q. <br /> Depth to water ~ '-�I Buckets bentonite l . <br /> Bags sand/gravel <br /> Mix Ratios Filter Pack type size 1*� <br /> Installation Method Surge Block:_- U_ n_)_ <br /> Quantity Installed Discussed with geologist: -( / n ) <br /> EH 29 29 <br /> Type of method �• <br /> ' <br />