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� 1 <br /> MONITORING WELL INSTALLATION REPOaf <br /> Date: 3 2Z:" i //��� /n CONSTRUCTION u I <br /> Premise Address: Z(-D3 l O t& 'g Total Depth <br /> Screen Length (from) . <br /> WellNo.: Filter Pack (from) 4 Z' (to) t(R 5 <br /> Bentonite (from) LO' (to) L(Z <br /> Inspector: ' Grout (from) -5 (to) Yo` <br /> Drilling rig type <br /> Permit No. 3� Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company:� <br /> �( � f Y casing <br /> Driller: height <br /> Consultan <br /> Geologist s �� Agpt/E GROUND CHMM-8OX ' <br /> COMPLETION COMPLEiICN <br /> SPECIAL PERMIT INFO. rd Surface —_ <br /> Distance to sewer line_ <br /> grout <br /> Domestic well on site - (y/rn'ak-4-9—ft. <br /> If yes, location and distance— Z• ft. <br /> _ m <br /> m <br /> O <br /> SAMPLING slotted <br /> tacion —_ <br /> Holding Temperature tiT' °Ipack <br /> Method = <br /> Screening Method <br /> Tracking Sheet - (y/ n) `" <br /> SPOILS <br /> Storage Method f �"�`�` V WL ERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n) Casing type (0" P U C.. <br /> Storage Location <br /> Blank H%{•7 ft. Screen S fr• <br /> Slot size O.O (n <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> t g sand/gravel <br /> Depth to water ��0.t I o Filter pa type/size <br /> Mix Ratios f Z Surge Block: - y n) <br /> Installation Method <br /> Quantity Installed iv a Discussed with geologist: - n ) <br /> Type of method <br /> EH 29 29 <br />