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? MONITORING WELL INSTALLATION REP- &T <br /> 3 �f o ( <br /> Date:. 5J ZD631 CON=UCTION <br /> Premise Address: I -(//��o ( I S a-d D Total Depth o <br /> j� Screen Length (from) Cro) <br /> Well No .: dJ ^ 1 Filter Pack (from) ([o) <br /> � 0 N Bentonite (from).(to). <br /> Inspector: Grout (from) (to) <br /> P Drilling rig type <br /> Perini[ No. Auger O .D. I-D, <br /> Completion • Stove pipe/christie box (circle one) <br /> Drilling Company: �hl�/16 <br /> D � �k casing _ <br /> Driller._ h-ti height <br /> Consultant <br /> Geologist <br /> A8C'VE-GAWN� C7^FilS'YcCX <br /> CCW ETION Cowl=ICN <br /> SPECIAL PERMIT INFO, tl Gf nd Sjxf c MT� <br /> �✓ r <br /> praut <br /> Distance to sewer line l <br /> Domestic well on site - ( y / n ) S � S <br /> If yes, location and distance - UP CST 1 <br /> Cio /so <br /> s q M2a <br /> SAMPLING <br /> n <br /> Holding Temperature 3o a.� 59 oil = 7'VV' <br /> Methodr Sy 1 <br /> Screening Method 31 a 2 ct b = <br /> Tracking Sheet • ( y / n ) /LO C / i / / L " — ♦ tL <br /> SPOILS Lif J / 00 <br /> Storage <br /> Storage Method $® 3 ��J�0TERIA -S/DEVELOPMENT <br /> Contamination Noted - ( y / n ) <br /> Storage Location kfc Casing type <br /> Blank fL Screen m <br /> D Slat size <br /> GROUTING (.P t� Bags cement <br /> Buckets bentonite <br /> Depth to water �0.ke�r l v 6 Bags sand/gnvel <br /> Mix Ratios Fater Pack typesize <br /> Installation Method Surge Block: - ( y / n ) <br /> Quantity Installed Discussed with geologist - C Y / n ) <br /> Type of method <br /> EH 29 29 <br />