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MONITORING WELL INSTALLATION REPT <br /> Date: � 9 7 CONSTRUCTION / <br /> Premise Address: 2S n)-c� L 1 1,ti4 Total Depth J- •J <br /> Screen Length (from)_ (to) <br /> Well No.: Filter Pack (from)-(to) <br /> Bentonite (from) (to) S <br /> Inspector: cod'�1 V7;b(31— Grout (from) (to) G�P-- <br /> Drilling rig type <br /> Permit No. Auger O.D. —9, 29- 2') <br /> Completion - Stove pi /christie box ircle one) <br /> Consultant <br /> Geologist Tl�'Tn * /Z4P1 _ sdek'up T <br /> T <br /> SPECIAL PERMIT INFO. ABOVE-GROUND <br /> COMPLETION CHgISTI'-BOX <br /> Distance to sewer line r COMPLETION <br /> Grou <br /> Domestic well on site -0/ n) nd 3ur<xa 7 � <br /> If yeas, location and distance - 9toout <br /> Is onyx ottsl+ <br /> -fD/L-Wb AUVK4ni76 cx�-g46,(�- Q n. <br /> tt. <br /> = o <br /> SAMPLING <br /> Holding Temperature f °c, idol "' <br /> Method C a*c9on „':•, <br /> Screening Method <br /> Tracking Sheet - y n) � <br /> k = <br /> qF <br /> tt <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Notes • n) N <br /> Storage Location S Casing type �;O'f+46 3 <br /> Blank ft. Screen /- ft. <br /> Slot size 0.07-0 <br /> Bags cement <br /> GROUTING Buckets bentonite / <br /> Bags sand/gravel <br /> Depth to water Filter Pack typ e J 1 7-- <br /> Mix <br /> Mix Ratios // /�C vI3N� Clslv2:6 L Surge Block: -� nn� <br /> Installation Method Gk4e� ert L. / Discussed with eologist: - (y n <br /> Quantity Installed Type of method :Vd6i,1- L&QA EMM Q <br />