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MONITORING WELL INSTALLATION REPORW <br /> Date: rt1� / 2 00 ' <br />{ Q .. ". CONSTRUCTION <br /> Premise Address, 4MU, r '�-�3G Total Depth <br /> F TWA <br /> Screen Length (from)_ Z c) (to) deg Piz <br /> Well No.- Filter Pack (from) 3 (to) �h <br /> Bentonite (from) L4- (to) -S % -`i <br /> Inspector. )© Grout t - _ (from) <br /> Drilling rig type { <br /> Permit No. d, Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casLng - <br /> x <br /> height <br /> r Consultant <br /> Geologist - <br /> -- ASCVE-GROUND C8stSTY-8oX <br /> COMPl.ETCN �.. COMPLEnON .1 <br /> SPECIAL PERMIT INFO. t G=nd Swfaca <br /> Distance to sewer line Qrart £; <br /> ,. Domestic well on site -(y/ n} _ x ; <br /> If yes, location.and distance - <br /> SAMPLING slam" 4y <br /> -soc'icn s• <br /> Holding Temperature r ' <br /> Method <br /> Screening Method <br /> Tracking Sheet - {y/ n <br /> a <br /> 3 <br /> SPOILS <br /> . • .i 1 <br /> Storage Method _- MATERIALS/DE VELOPMENT.� r <br /> Contamination Noted - (y/n ) <br /> Storage Location :. 41 _ Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUPING Bags cement <br /> ' Buckets bentonite <br /> Depth to water g Bags sand/gravel <br /> Mix Ratios 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 />