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MONITORING WELL INSTALLATION REPORP <br /> Date: CONSTRUCTION <br /> Premise Address: -2 3 9 8 7 f�w /n9 Total Depth �s <br /> Screen Length (from) RS (to) (oT <br /> Well No.: ✓N k7/ Filter Pack (from) £'S' (to) [03 <br /> Bentonite (from) 6 3 (to) (,a <br /> Inspector. hoz Grout (from) I-r) (to) 21±=5LO <br /> Drilling rig type &,Z10ma <br /> Permit No. 95 38 Auger O.D. k- w " I.D. <br /> Completion - Stove pipe/ tnsde o (circle one) <br /> Drilling Company: /w, �wQO <br /> Driller: casing <br /> he_ght <br /> Consultant l £ V _EWT <br /> Geologist /Yf i C Coc--c;� <br /> ABCVE-GACUND G¢iISTY-BOX <br /> C OWLErION CCMPLETICN <br /> SPECIAL PERMIT INFO. Ground S TIiQt Tom` <br /> Distance to server line RR, <br /> grout <br /> Domestic well on site - (d n ) 7 ft. <br /> If yes, location and distance - ft. <br /> — - m <br /> = o <br /> C <br /> — a <br /> SAMPLING dorsi <br /> soden <br /> Holding Temperature O/c vc e p�vd yxsc <br /> Method = <br /> Screening Method <br /> Tracking Sheet - ( ri _— <br /> SPOILS <br /> Storage Method ((Py <br /> MATERIALS/DEVELOPMENT <br /> Contamination Noted - `( n ) <br /> Storage Location Casing type fwr- a <br /> Blank_(a!L� _ft. Screen 2 ft• <br /> Slot size . 010 <br /> GROUTING Bags cement 9(9 s t — <br /> Buckets bentonite / 4.yV�Z- — <br /> Depth to water Bags sand/gravel 5_ <br /> Mix Ratios Neu. Filter Pack type/size 2 /2 <br /> Installadon Method tae _-�f_— Surge Block: - ( y/ n ) ? <br /> Quantity Installed 90 5, It Discussed with geologist. - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />