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MONITORING-WELL INSTALLATION REPORT <br /> Date: Iof(55 �Oe CONSTRUCTION <br /> Premise Address: �(I t( C/L�e E�tn) - __ Total Depth <br /> Screen Length (from) -4- t ` (to) �R t <br /> Well No.: M W-\a -`3 Filter Pack (from) ` (to) S t J <br /> Bentonite (from) (to)- <br /> In <br /> to)— <br /> inspector, N . r c t, Grout (from) _;q, (to) 6� <br /> Drilling rig type_Tc. %:c <br /> { Permit No. L-I Ll I S Auger O.D. I.D. <br /> 1 Completion - Stove pipe/cluistie box (circle one) <br /> { Drilling Company <br /> acasing <br /> � <br /> Driller: � "� he±5ht <br /> Consultant Cr,n ln� `9 +T <br /> Geologist �rn J s^� AA y AA T <br /> APCVE-GRCtJND A SLl 30X ' <br /> CO r'LEI CN TIC <br /> Ground <br /> SPECIAL PERMIT INFO. Suix+ <br /> pra.: <br /> Distance to sewer line <br /> Domestic well on site - ( n) _S_-kzs--1t• <br /> If yes, location and di nee - h• <br /> = o <br /> SAMPLING ilarai <br /> soden _ <br /> Holding Temperature <br /> Method = _ <br /> Screening Method <br /> Tracking Shce[ - y1 r j = ' <br /> tt <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contaminadon Noted - (y <br /> Storage Location a t Casing <br /> lame type� I ' fr,vG Screen Lo —h• <br /> Slot size_ o LO — <br /> GROLMNG Bags cement <br /> Buckets bentonite l <br /> Depth to water +� `�O Bags sand/gravel N3 <br /> ) Gr� rt vm ( (14� ) Filter Pack type/size z <br /> MIX Ratios rz <br /> dttstallation Method CLl�iat � Surge Block: (Y4 n <br /> Quantity Installed N G Discussed with geologist: - (y�r ) <br /> Type of method <br /> EH 29 29. . <br /> i � <br />