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MONITORING WELL INSTALLATION REP* <br /> Date: 6 . CONSTRUCTION <br /> Premise Address: I Total Depth 7• S <br /> Scree Length (from) (to) <br /> Well No.: �A ( : Filter Pack ) ) <br /> Bentonite (from)_ (to) <br /> Inspector: Grout (from) to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Consultant <br /> F0'!5U =tc. (3AJV"Zoti M wig-AL 614DU P Completion - Stove pipe/christie box (circle one) <br /> /Geologist 'Ple il. tz, t—iticS uP <br /> T <br /> SPECIAL PERMIT INFO. ABOVE•GROUN <br /> / COMPLETIONCNRISTY-80X <br /> Distance to sewer line SD COMPLETION <br /> in <br /> Domestic well on site - y SLA + <br /> If yes, location and dist ce - Afoul <br /> f wa'1LY 1S Ih•1U.1 �,U- so TJIr' <br /> �Ul[-CsfS �Yc-r.�v`GfJ/arG �U O�tctS Fd>'GS�alh.It,Z. ft. <br /> ft. <br /> 14. -_ <br /> SAMPLING J�• 7—O.S 1 j� �7- c <br /> Holding Temperature 4° nod "•' __ <br /> Method O° <br /> Screening Method u = gmvW Pack <br /> Tracking Sheet - y In <br /> ,.4 <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Notes - y n ) <br /> Storage Location OA/ 91U— C Ing type <br /> Blft Screen fr. <br /> Slot size <br /> Bags semen <br /> GROUTING Buckets bentom <br /> i Bags sand/gr el <br /> Depth to water —7 Filter Pac a/size <br /> Mix Ratios Surge B ck: - (y/n ) <br /> Installation Method -Mt4k 4J fikw OWAo'h 6 MW— Discussed with geologist: - t,/ n ) <br /> Quantity Installed Type of method <br />