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r <br /> MONITORING WELL INSTALLATION REPORT <br /> awl <br /> avq _4;W3 <br /> '' II ows <br /> Date: �i� �0 '• CONSTRUCTION <br /> Premise Address: Total Depth -70 <br /> Screen Length (from) 7 (to) !n <br /> Well No.: /)LJ 0 W ? � 1A 3 Filter Pack (from) (to) <br /> Bentonite (from) fp (to) 6z <br /> Inspector. Grout (from) IN ;L (to)_ box <br /> 7 Drilling rig type Ha Ito W S te.—axsen <br /> Permit No. 7 5 I Auger O.D. '8" I.D <br /> I,, (I \ I Completion - Stove pipe c tristie b � (circle one) <br /> Drilling Company: � ( �r.�'11� 1I�(� �` (�- <br /> Driller: casing <br /> height <br /> Consultant �� y <br /> r*I p <br /> Geologist YR I` ISgy- <br /> ABOVE-GRCUN� <br /> COWLETION QiRZTY-Box <br /> CCNU LETICN <br /> SPECIAL PERMIT INFO. G=rd Stzian <br /> Distance to server line afO <br /> Domestic well an site <br /> - Cy/(V(y// t� �,2 <br /> If yes, location and distance <br /> — a <br /> = m <br /> = o <br /> - — c <br /> SAMPLING slonAi <br /> soricn - — <br /> Holding Temperature <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> • � tt. 'I' _ � ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type PV(Z,, <br /> Blank I — toy I/i ft Screen ���= ��(o fr• <br /> Slot size <br /> GROUTING Bags cement <br /> r Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> installation Method Surge Block: - (y/n) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 2929. Uu)l. aW +ro^sf c� OW3 aoGe fele- Glee {o uJ�er <br /> la n <br /> orb%.+ a.11 ow We ((g gs4rkc�ran WttlaXrou ��erLyL��I-emrxli� <br /> W L 5 <br />