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MONITORING WELL INSTALLATION REP',.,,' <br /> Date: 11 Irl rl CONSTRUCTION <br /> th Total Dc <br /> Premise Address: ��(7 JIC��YLp P <br /> Screen Length (from) (Eo)-5-'g ' <br /> Well No,: AA IA) "'7 Filter Pack (from) L-11 ' (to) <br /> Bentonite (from) V (to) 1 <br /> Inspector. _ .b inti& fotlp Grout (from) 8 (to) '!O <br /> Drilling rig type <br /> Permit No. 7:? Auger O.D. to it I.D. <br /> Completion - Stove pipe/chrisrie box (circle one) <br /> Drilling Comp my: !`!.�-� i �� M✓ <br /> Driller: CA,...J•Scasing <br /> 7- height <br /> Consultant_X11,p AA& <br /> Geologist.�e0(07 - <br /> �6 ABOVE.GACUND CF4ltST'Y30X <br /> COA�Li=fbN CCMPLEnCN <br /> SPECIAL PETIT INFO. Ground Surtaet <br /> Distance to sever line grout <br /> Domestic well on site - (y/ n ) {p tta <br /> If yes, location and distance - ft <br /> a <br /> _ . <br /> SAMPLING donna = c <br /> sacicn — <br /> HoldingTemp:rarure cr, i • = P�YdG <br /> Methods <br /> Screening Metiod P I t) <br /> Tracking Shce - (ly n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/09 „ P J <br /> Storage Location (510 5�,�_ Casing type <br /> Blank ft. Screen 1 5 h. <br /> Slot size - O 1 O <br /> GROUTING Bags cement N L7, <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel 5 <br /> Mix Ratios v Filter Pack type/size 2- t 7 <br /> installation Me Ada . (v b Sty+ � Surge Block: - ( y/�n <br /> Quantity Instal ed Discussed with geologist: - ( y}fin <br /> Type of method <br /> EH 29 29 <br />