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""-MONITORING WELL INSTALLATION REPL`I' <br /> Date: t 6. /3 ,9 / CONSTRUCTION <br /> Premise Address: 2Z�f - C 4gwu�_` Total Depth `J <br /> 1 Screen Length (from) (to) <br /> Well No.: V UU Filter Pack (from) (to)_ 1 <br /> C� J1�e - Bentonite (from)_ 2- (to) '11, 6 <br /> Inspector: Grout (from) //. (to) b-- <br /> Drilling rig type <br /> Permit No. / 4 Auger O.D. /0,7< J <br /> Completion - Stove pipe/ stie box (circle one) <br /> Consultant LU' �1.tD7 Assns <br /> Geologist (�-na�sC,1xr.) stfc�c-up <br /> SPECIAL PERMIT INFO. <br /> ABOVEGROUND CMSTY4= <br /> Distance to sewer line ( e'- COMPLETION COMPLETION <br /> Domestic well on site - (y/(n Ground Sumacs <br /> If yes, location and distance - grout <br /> . f!. <br /> ft. <br /> SAMPLING p <br /> Holding Temperature <br /> Method !Jl/ IC 7- aac�on <br /> Screening Method Yrgmvw Pack <br /> Tracking Sheet y n) <br /> q .:z <br /> 1l. vw t. <br /> SPOILS <br /> Storage Method P���S n L- MATERIALS/DEVELOPMENT <br /> Contamination Notes - y ' n ) „ <br /> Storage Location O)tT 317-0 Casing type SC4 40 <br /> Blank ft. Screen <br /> Slot size b• O?� <br /> Bags cement Lr� <br /> GROUTING Buckets bentonite____,Z 66tZ n <br /> Bags sand/gravel <br /> Depth to water Filter Pack type/size 1 T- _ <br /> Mix Ratios q Surge Block: - (y/ - <br /> Installation Method Discussed with geo gist: - ( n ) <br /> Quantity Installed Q6�r Type of method ��a� _ __ <br />