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y <br /> -MONITORING WELL INSTALLATION REPOr%:f <br /> Date: �s 093 CONSTRUCTION <br /> Premise Address: �O &6 Total Depth 3� <br /> a Screen Length (from) -(to) <br /> Well No'.: /� Filter Pack (from) 33 _(to) a 2 5 � <br /> Bentonite (from) 2Z (to) <br /> Inspector: Grout (from) (to) <br /> p Drilling rig type <br /> Permit No. D8.3�2 a Auger O.D. LD• <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: L� - <br /> Driller: �Q - 7` casing <br /> / height <br /> Consultant T7 TF <br /> Geologist " ABOVE-GROUND f <br /> aHRLM43OX <br /> COcOMPt.E <br /> MPLETION ompLe <br /> _ f1OtJ <br /> SPECIAL PERMIT INFO.Surface <br /> grout ' <br /> Distance to sewer line <br /> Domestic well on site - (y _ t5 <br /> ft <br /> If yes, location and distance - •�"�I/Z-- <br /> --L <br /> .rys o <br /> SAMPLING , ri slotted — <br /> �,, sat�an <br /> Holding Tema afore � <br /> Method t — <br /> ;t — <br /> Screening Method40V A4 <br /> ` —_ <br /> Tracking Sheet - n} ,• <br /> SPOILS f/ <br /> �- v MATERT ^,MLOPMENT <br /> Storage Method <br /> � �. � a <br /> Contamination ;f[� <br /> Noted - n) w_ <br /> - Storage Location � � ' �: � . ; �; Casing type y r ft. � <br /> y s , Blank ft. Screen <br /> Slot size-- <br /> GROUTING = ` Bags cement <br /> "• "y- c' `"� �" 4 Buckets-bentonite`=` <br /> �- �, , �_ r Bags sand/gravel <br /> Depth to water -- Z s ' t t. Filter pack type/size <br /> Mix Ratios - <br /> Installation Method '� - Surge Block:'-`(y n 59n) <br /> Discussed.with geo ogist:.,-;(y <br /> Quantity Installed . <br /> Type of method <br /> EH 29 29 .q <br />