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I! ^tITORING WELL INSTALLATION REPOR'r <br /> Dace: 'n- I �" CONSTRUCTION <br /> r <br /> Premise Address: a3 6 OAPAs ti Total Depth <br /> r Screen Length (from) oP-b (to) S <br /> Well No.: W ( w �.( Filter Pack (from) (to) r <br /> Bentonite (from) 5E' (to) 3' <br /> Inspector. Grout (from) 3 (to) . <br /> U Dulling rig type kpeJ a 1 <br /> Permit No. bb b 3 Auger O.D. :z " I.D. <br /> Completion - Stove pipeo ns e b z (circle one) <br /> Drilling Company. <br /> Driller. casing <br /> �_ height <br /> Consultant _ <br /> Geologist <br /> ASCVE-GRCUND CHSiSY-aCX <br /> CrMPC_=,i;CN CC&4PL=TICN <br /> SPECIAL PERMIT INFO. G=nd Suia= <br /> Distance to sewer line gran <br /> Domestic well on site - (y/ n) <br /> If yes, location and distance - n_ <br /> v a <br /> — C <br /> SAMPLING ttorai = c <br /> sQcxn -' <br /> Holding Temperature __ �nvd;,aac <br /> Method — <br /> Screening Method = <br /> Tracking Sheet (y/ n) <br /> SPOILS <br /> Storage Method 5 MATERIALS/DEVEI.OPMENT <br /> Contamination Noted- ( n ) N $ V G <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size a / <br /> GROUTING Bags cement-----L <br /> f Buckets bentonite I <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack typesize Y <br /> Installation Method Surge Block: - ( y/ n ) <br /> Quanciry Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />