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MONITORING WELL INS.T`ALLLA71O1{N REPORT <br /> Date: 7�Z� CONSTRUC I <br /> Premise Address: �«M �U 1. Total Depth 6� <br /> Screen Length (from) 4q (to) <br /> Well No,: T Filter Pack (from) 7— (to) <br /> Bentonite (from) Z- (to) u <br /> Inspector. ^ ' Grout (fro Z— (to) <br /> Drilling rig t}�e <br /> Permit No. Auger O.D. S� I.D. L <br /> Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company: L$4� <br /> Driller: FW— <br /> ABOVE-GFICUND <br /> casing <br /> Consultant /T �� height <br /> C/Geologist I /� �' Ct4ilSTY30X <br /> COWLE'rION CC APLETICN <br /> SPECIAL PERMIT INFO. Ground Sui'ca <br /> Distance to sewer line Graft <br /> Domestic well on site - Xy n) IL <br /> If yes, location and dista ce - n, <br /> R. <br /> e <br /> S <br /> SAMPLING dorsad <br /> tocicn <br /> Holding Temperature _ Cravat yacst <br /> Method q' _ <br /> *xc = <br /> Screening Method — <br /> Tracking Shcet - (y/ n ) <br /> E 4 ) ft. = tt. <br /> SPOILS ���� <br /> Storage Method ( l6<^'�> / J �� t( f N MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) —� a upyc" <br /> Storage Location Casing e <br /> Blank ft. Screen Za f<• <br /> Slot size _of 0 <br /> GROUTING Bags cement <br /> Buckets ben[on to Solt <br /> Depth to water SS Bags sand/gravel <br /> Mix Ratios YtL Filter Pack type/size /Zr <br /> installation Method�/i1a.1� Surge Block: - (y t ) <br /> Quantity installed Discussed with geo ogist: - Y/ n) <br /> Type of method <br /> EH 2929 /Ar <br />