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ONITORING WELL INSTALLATION REPO <br /> Date: CONSTRUCTION <br /> Premise Address: �l�il� 9Z6f'LC , Total Depth 1 <br /> Screen Length (from) (to) <br /> Well No.: \l Filter Pack (from) (to) <br /> Bentonite (from) (to) 2c� <br /> Inspector: Grout (from) ,-10 (to) d— <br /> Drilling rig type <br /> Permit No. CF — (710 Auger O.D. I.D. <br /> Completion - Stove pip trtstfe bo (circle one) <br /> Drilling Company: <br /> Driller: / ��CN �� casing GW—f he+_qhtConsultant /� -- <br /> Geologist /LI Lfr4rw')� At i�L w 7— <br /> ABCVE-GRCUND Ct4i1M43OX <br /> CON PLE'r*N CCMPLEEICN <br /> SPECIAL PERMIT INFO. G=nd 8uAx� <br /> T <br /> Distance to sewer line_ l E aroA <br /> Domestic well on site 7(y%n ) <br /> If yes, location and distance - n- <br /> R. <br /> SAMPLING slora� <br /> Holding Temperature _ rra past <br /> Method U"I !t <br /> Screening Method <br /> Tracking Sheet n ) _: <br /> it. = ft. <br /> SPOILS <br /> Storage Method IZi!l J MATERIALS/DEVELOPMENT <br /> Contamination Noted - y' n ) <br /> Storage Location Cil S>1Z Casing type �L S( HU nb i11 <br /> Blank -G ft. Screen, 'ZJ ft. <br /> Slot size 0, i <br /> GROUTING Bags cement <br /> Buckets bentonite 2 `a cu c f5 <br /> Depth to water_ Bagssand/gravel <br /> Mix Ratios %� z ter) Filter Pack type/size <br /> Installation Method Surge Block: - ( y/ n ) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />