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MONITORING WELL INSTALLATION REPOnT <br /> Date: 1�� l/�/�_/p�' / Q CONSTRUCTION y <br /> Premise Address: 7 L7� e�c� ��Clur Total Depth <br /> l / Screen Length (from) 2, (to) !3 <br /> Well No.: �'L T fri Cpl Filter Pack (from) 2-5 (to)��— <br /> Bentonite (from) !L (to)— <br /> Inspector: Grout (from) —(to) D <br /> Drilling rig type Ax 9/w. _ <br /> Permit No. C 6 Auger O.D. I.D. <br /> Drilling ``y: <br /> Completion - Stove pipe/christie box (circle one) <br /> Company: <br /> Driller: / `4%� 1IF71T <br /> casing <br /> Consultant height <br /> Pin FT <br /> Geologist ABCVE•GRCUND <br /> COLFLETCN CNpt.E BOX <br /> CCMtAPLETIO <br /> SPECIAL PERMIT INFO. Ground$Urian <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) 1 / n. <br /> If yes, location and distance - 6L ft <br /> m <br /> SAMPLING tlol = E <br /> saMon <br /> Holding Temperature - gmw Pack <br /> Method = <br /> Screening Method = •'• <br /> Tracking Sheet - (y/ n ) <br /> ft. tt. <br /> SPOILS 2W ?S lye--k PU(� <br /> 2 5 ik+^70 <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) �j n �V-L <br /> Storage Location Casing type lI <br /> Blank Zj ft. Screen / ft. <br /> slot size .Q IQ <br /> GROUTING Bags cement <br /> 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 29 29 <br />