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y MONITORING WELL INSTALLATION REPORT <br /> n ,0Z2 <br /> 0,64 <br /> Date: I� �)eC OS. CONSTRUCTION bt�cicwti+c. <br /> 2 010 t �Z 77G 4 S®'4 Total Depth /� r 3:20 rov tx <br /> Premise Address: P <br /> A�/�ce Screen Length (from) (to) 91B <br /> Well No.: ���� // Z Filter Pack (from) 7�- (to)_ '��e <br /> ' Bentonite (from) '7i (to) 75 <br /> Inspector. 1412-Irl- Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company: <br /> Driller: �� casing <br /> he±ght <br /> Consultant <br /> Geologist ABOVE-GRCUND <br /> COWFL.�TION CMPLEnOX <br /> COMPLE7ICN <br /> SPECIAL PERMIT INFO. Grourd S�rlact <br /> Distance to sewer line ora t <br /> Domestic well on site - (y/ n) ft. <br /> If yes, location and distance - }t, <br /> ft. <br /> V' <br /> O <br /> SAMPLING ilorod = S <br /> socion Holding Temperature = gnvdpaoc <br /> Method r = <br /> Screening Method _ <br /> Tracking Sheet - (y/ n ) _ <br /> R. = tt• <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) 'IStorage Location Casing type / <br /> Blank ?d fr. Screen ;?Li h. <br /> Slot size 021 <br /> GROUTING Bags cement <br /> Buckets bentoniteto ip 5 7/6 — <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 vAth geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />