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1 TITORING WELL INSTALLATION REPOR" <br /> 737- 2 <br /> 2't —0 �.1 • �U <br /> 2— <br /> to Z ' �� 3 9 l CONSTRUCTION <br /> Premise Address- G�GllJCse Total Depth <br /> Screen Length (from) r a (to) <br /> Well No . � � 3 Filter Pack (from)._ 214 (to)_ 7 <br /> Bentonite (from), -7 —(to)� 6' <br /> Inspector Grout (from) (to) C> <br /> Drilling ng typ 44sA <br /> Auger O.D.Au 3 <br /> Permit No_..._,.,, — g <br /> Completion - Stove pip chnstie box (circle one) <br /> Consultant j��,�� <br /> GeologistA " sOdc-up <br /> T <br /> SPECIAL PERMIT INFO 118011£-GR D <br /> CO!VIE4 ION CHRI$T 4= <br /> Distance to sewer line Al ComnETION <br /> C3rocir�d Surface <br /> Domestic well on site - ( y n <br /> If yes, location and distance - grail <br /> r n. fl. <br /> ` •I o <br /> y- <br /> SAMPLING <br /> a _ s <br /> HoldingTemperature dontd <br /> Method .A- "=On <br /> Screening Method u v = 9M Park <br /> Tracking Sheet n) _ <br /> SPOILS ~ <br /> Storage Method . � MATERIALS/DEVELOPMENT pa{,wAe _ <br /> Contamination Notes - ( y ) Z�` 1ef c- SA,- 7-t) <br /> MN Location �Q Casing type <br /> Blank q ft. Screen----15-ft <br /> Slot size .O 2:D <br /> Bags cement I <br /> GROUTING Buckets bentonite ` <br /> 11 , �i Bags sand/gravel, <br /> Depth to water s''"L Z Filter Pack type/size LS+� <br /> Mix Ratios 0 —' BO S°t�� Surge Block- - (y/ n ) <br /> Installation Method Discussed with geologist: - 5ZY n) <br /> antity Installed U I NA64 AC& Type of method _ <br /> �� 5 �•3 r f j ,/�� � 21 ..3 <br />