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S Uc-a r <br /> y 'MONITORING WELL INSTALLATION REPORT <br /> Date: I'�9' p/Y �O � � CONSTRUCTION <br /> Total Depth i/2- <br /> Premise Address: /C� c90 / ��u �' Screen Length (from) (to) <br /> Well No.: Filter Pack (from) 8-/ %r (to) 77 ' <br /> Bentonite (from) 7 7 (to) <br /> �"9 _ <br /> p-rS u.dr� t'ut (from) ?S (to) <br /> Inspector: (21 C2 y so` Drilling rig type <br /> oto^ Auger O.D. <br /> Permit No. Z� Completion - Stove pipetie box ( ircle one) <br /> Drilling Company: <br /> I�Pi�dle IF <br /> casin <br /> tDriller: - heigh <br /> VjW- <br /> Consultant o ,--, <br /> Geologist 2' � N' s ABOVE-GROUND CHR*Iry-gpX <br /> COMPLETION CCMPLEnCN <br /> Ground Surfs" <br /> SPECIAL PERMIT INFO. <br /> n 1 Omit � <br /> Distance to sewer line _ co <br /> Domestic well on site - (y/ n) <br /> If yes, location and distance - bo tt' <br /> A O <br /> - <br /> sc, <br /> C <br /> SAMPLING sell = $ <br /> Holding Temperature <br /> S-S�c14Y <br /> Method . wd <br /> Screening Method ° Ic&, sN o) <br /> Tracking Sheet - (©/n ) $ <br /> n, n. <br /> SPOILS <br /> Storage Method S� MATERIALS/DEVELOPMENT <br /> = S�e,,1�- mow <br /> Contamination Noted - 0/ s Casing type plc a,, rs <br /> Storage Location o Blank ft. Screen---a-L/—i'— <br /> Slot <br /> creenp- L/i'---Slot size O z- <br /> N �- Bags kement/(l ^ <br /> GROUTING N= * "�i ' <br /> Buckets bentonite <br /> Bags sand/gravel c <br /> Depth to water S Fo Filter Pack type/size ' <br /> Mix Ratios itiA�SF ��""� <br /> Surge Block: - (�/ n) S"�T- <br /> Installation Method fro Discussed with geologist: - (y <br /> Quantity Installed �Lm Q u Type of method v oa <br /> EH 29 29 <br /> G(pn�P'4 C�J4i u t Cn CslTv erI°t� ® LaL <br />