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�' � � !� '✓98 - .3 c,�-e-�o ��`�,��) ✓E�(!� CJS_ <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: 7-80- 9 8 d("71;/I<Y 5 -Lec L 4 0 CONSTRUC i ION C V �7 � <br /> Premise Address- £ /Ax o , Total Depen 3- <br /> /RS s� <br /> b, 3 Screen Length (from) a s (to) 3 s <br /> Well No.: I/(�J3T�±1 / cr=w fir, c- Wo.� FU=Pack (from) -%5' (to) 2.3 <br /> Inspector. C' • a z Grout (from) Z3 (to) 7- <br /> Drilling <br /> Dulling ng type <br /> Permit No. Auger OD. I.D. <br /> Completion-Stove pipe/chrisrie box (circle one) <br /> Drmmg Company <br /> Duller: CasingV 6/ S = Eeight . <br /> Consultant <br /> iY7/�Q A <br /> Geologist s a n ~ <br /> iL9OVEvACtlND t7i"i,5"!aCx <br /> C^,;AhPL-i k7N C.'YdP_-1CN <br /> SPECIAL PM- Mr-i INrO. re 'ef A <br /> i <br /> prat. <br /> Distance to sewer line <br /> Domestic weL on site - C Y/ n) <br /> If yes, locarion and distance - PaJ.��u $e wlw�' f,a L4 <br /> sA YTLING + <br /> Holding Temperature <br /> Method <br /> Screening Method —' <br /> Trac)cing Sheet - (y/ n) <br /> r ♦ _ ♦ 3 s t,. <br /> SPOILS <br /> Storage Method MAITRIAIS/DEVELOPMQIr-' <br /> Contaminarion Noted- (Y/n) �` L <br /> Storage Location rasing <br /> Blank a�C fL Screen �F- <br /> Slot si CZD <br /> GROUTING Bags omen <br /> Buckets beamnKn / <br /> Depth to ware- 3 S Bags sand/gravel <br /> Mix Rarios Filter Pack type/size d <br /> Installarion Method Surge Block - (y/ n ) <br /> Quantity Installed Discussed with geologsn - C Y/ n) <br /> / Type of merhod <br /> Eli 29 29 <br />