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MONITORING WELL INSTALLATION REP R ' <br /> Date: CONSTRUCTION <br /> Premise Address: Gr i Total Depth <br /> Screen Length (from) /5 (to) 6- " <br /> Well No.: i-),YW9 r2w3 _ Filter Pack (from) /S (to) Y ' <br /> Bentonite (from) Ll ' (to) 5 " <br /> Inspector: Grout (from) (to)� <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion . Stove pipe/cluistie box (circle one) <br /> Drilling Company; G� <br /> Drillerd � <br /> � –•� casing <br /> T height <br /> Consultant �5 V <br /> Geologist <br /> 7/49 <br /> ABOVE-GROUND c�-s��srr-Rax <br /> GQl4.'1..�TIO N <br /> SPECIAL PERMIT INFO. G'nd Sutacf <br /> Distance to sewer line grout <br /> Domestic well on site - ( y 16) tt. <br /> If yes, location and distance - n- <br /> fi. <br /> 0 <br /> 0 <br /> SAMPLING �lorn�i c <br /> secicn <br /> Holding Temperature ;-r:c 5�— VIVW Pads <br /> Method <br /> Screening Method .r <br /> Tracking Shcet - V n ) ir — <br /> SPOILS <br /> Storage Method 3 " � MATERIALS EVEi.OPMENT <br /> Contamination Noted - (y/ n_) <br /> Storage Location Casing type a2 <br /> Blank 5' fL Screen 7c� fr• <br /> Slot size QaO <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size Sin <br /> Installation Method Surge Block: - (y/a?) <br /> Quantity Installed Discussed with geologist: - n ) <br /> Type of method_ .a o� <br /> EH 29 29 <br /> o <br /> ,/o <br />