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MONITORING WELL INSTALLATION REPOnf <br /> Date: DEQ% ��o/Lc9o5 �Fjrr� CONSTRUCTION <br /> e +� <br /> Premise Address: O l Total Depth //0 <br /> /� `�` ✓ ' <br /> c Screen Length (from) /075 (to) <br /> Well No.: '/a Filter Pack (from) / /6 (to)� <br /> Bentonite (from) 8y (to) <br /> Inspector: « Grout (from) (to)- <br /> 7 <br /> to) 0 <br /> Drilling rig type 13.C�— <br /> Permit No. Auger O.D. 10 I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: 7 casing <br /> height <br /> Consultant Jl -e <br /> Geologist 1 <br /> A80VE-GRWND CNAI57Y-BOX <br /> COWLECION <br /> SPECIAL PERMIT INFO. Ground Sunt'°° + �� <br /> V T <br /> 7 gw <br /> Distance to sewer line <br /> Domestic well on site - (y/ n )� tie/ �SL1d' ft. <br /> If yes, location and distance - (// �i� ft. <br /> .S2=ft. <br /> q <br /> _ O <br /> - C <br /> O <br /> SAMPLING dotted c <br /> &edon <br /> Holding Temperature Nod` `'es = cn tw <br /> Method = <br /> Screening Method =_ <br /> Tracking Sheet - (y/ n ) <br /> t <br /> SPOILS �— <br /> Storage Method 4Y,"1 0_U�9�— MATERIALSLDEVFLOPMENT <br /> Contamination Noted j� Casing type <br /> n ) <br /> Storage Location 20 ft <br /> Blank 85 fr. Screen <br /> Slot size �O D <br /> GROUTING Bags cement // f �� fi G <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel /6 <br /> Mix Ratios t Filter Pack type/size /2 <br /> Installation Methods u J*V, w Surge Block: - (y <br /> PeLlQuantity Installed f Discussed with geologist: - (y <br /> Type of method N1 <br /> EH 29 29 <br /> �21i bl os Aw- <br />