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r <br /> MONITORING WELL INSTALLATION REPOR"t <br /> Date: � CONRUCTION <br /> !? <br /> �3� Total Depth <br /> /�l 6J4 (� ^/3/ <br /> Premise Address: <br /> Screen Length (from)9 <br /> Well No.: � Filter Pack (from) Z�([o) <br /> Bentonite (from) (to) / 3 <br /> Inspector: v'rr 6 Y Grout Morn)—L.1—(to) <br /> �,r'4– Drilling rig type <br /> Permit No. �Z 2G �� Auger O.D. 4 <br /> Completion - Stove pipe/ uistie b circle one) <br /> Drilling Company: �-� <br /> Driller•. �/ ��� height <br /> ing <br /> Consultant "' •� - IV r \ <br /> Geologist 'w <br /> ABOVF-GROUND CHSMI1•y-goX <br /> COMPLETION CCMPL.=nCN <br /> SPECIAL PERMIT INFO. GroundIS '� <br /> 'nA 1. ► g grout <br /> Distance to sewer line <br /> Domestic well on site - (y/ n ) it ft. <br /> If yes, location and distance A, I tt <br /> tt. <br /> .y? <br /> 0 <br /> SAMPLING doral <br /> sadden = <br /> Holding Temperature <br /> –_–/7/' 71velpxsc <br /> Method '' _ <br /> z:.. _ <br /> Screening Method _ <br /> Tracking Sheet - (y/ n) gQ� <br /> SPOILS <br /> Storage Method MATERIALS/DEVEI.OPMENT <br /> Contamination Noted - .�` <br /> Storage Location 1S1 Sl\1 7 Casing type <br /> Blank ft. Screen h• <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite 1dfav1:=: r�wro //L <br /> Depth to water Z( .— Bags sand/gravel <br /> Mix Ratios 5aehs Filter Pack type/size <br /> Installation Method cz ti . Surge Block: - / n ) o / e;f <br /> Quantity Installed zY /o Discussed with geologist: - (y/ n ) wllbi- - <br /> 9 Type of method <br /> EH 29 29 V i�C�Cv Cil . <br />