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MONITORING WELL INSTALLATION REPO <br /> Date:_�sC —��Z' CONSTRUCTION <br /> Premise Address: � ' Total Depth <br /> /�� Screen Length <br /> Well No.: '1 Filter Pack (from) /Z S (to) /,o Z._, <br /> Bentonite (from) /0,7 (to) /Oz <br /> Inspector: Grout (from 0 Z (to) U <br /> ng rig type! T <br /> Permit No. -S-e O6��v Auger O.D. /.,I I.D. <br /> / Completion - Stove pipe/christie box (circle one) <br /> Drilling CCo� ompans,�: IDriller-NY7 :!/Ju.C- /YG�! —/ cocas <br /> Consultant f G� <br /> Geologist / CHAIM43OX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. � rlac —F � <br /> grout <br /> Distance to sewer line �'�" /0 Z— ft. <br /> Domestic well on site -Q n ) _ �Z/> <br /> If yes, location and distance - A /,/ L�/� .r�/J ft. <br /> AI �` /J ! M oft = m <br /> 1-7;) 1,7 = e <br /> 0 <br /> /D 7 <br /> SAMPLING /C)7 slotted _ S <br /> dClGo` I wc6an <br /> Holding Temper tune VZYW P <br /> Method <br /> Screening Method — ' <br /> Tracking Sheet -G7 n ) 3 =_ <br /> SPOILS <br /> Storage Method /,g//,j [ALS/DEVELOPMENT <br /> Contamination Noted - (:2:)n ) Z r�V e <br /> Storage Location N�ilv*! !►'Q �Q` 'F Tpe <br /> ft. Screen /T ft. <br /> ,010 <br /> GROUTING ment Zb t <br /> bentonite <br /> Depth to water `-t/0e) Bags sand/gravel Eno <br /> Mix RatiosFilter Pack type/size 3 <br /> Installation Metl od t`"4e Surge Block: - (y/ n ) <br /> Quantity Installed t Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br /> '�—i 12 — 2ut a Z44WI 13 <br />