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MONITORING WELL INSTALLATION REP-e-r <br /> Date: l D/Z 5— 2- 7 / 6 CONSTRUCTION <br /> e h � � • <br /> Premise Address: r)"/l �1`t"A Total Depth <br /> Screen Length (from) (to) <br /> Filter Pack (from) (co) <br /> Well No.: Bentonite (from) (to) <br /> Inspector. 4� Dy rir (from) (to) <br /> Drilling g type e <br /> Permit No. Auger O.D. J> I O <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company. <br /> casiaq <br /> Driller. height: <br /> n / nno,L(� r� r � <br /> v <br /> Consultant-K r <br /> Geologist �- i Awv=-GRCUNO �,A�S-•,•3pX <br /> CCWLET;CN CCMpt=,ICN <br /> Ground Stxf� <br /> SPECIAL PERMIT INFO. <br /> r � <br /> Distance to sewer line �m ov 2-1" T9 <br /> Domestic well on site - ( y/ n ) <br /> [f yes, location and distance - � 411- - ---k <br /> 94 <br /> s <br /> a <br /> abctnd ZI, `a <br /> SAMPLING ween '- <br /> Holding Temperature <br /> Method <br /> Screening Method <br /> Tracking Sheet - C y/ n ) AL tL_ <br /> SPOILS s} - T' <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n) Casing type <br /> Storage Location Blank LH fc Screen t d —ft. <br /> Slot size C <br /> GROU LING Bags cement <br /> Buckets bentonire <br /> Depth to water6 t7 J') Bags sand/gravel <br /> Filter Pack type/size-'.41 <br /> Mix Ratiosi"�" Surge Block: - C y/ n ) <br /> Installation Method � Discussed with geologist - ( y/ n) <br /> Quantity Installed SQt ` �S/ 9 Type of method <br /> EH 29 29 <br /> 2 Tos-v ;�6S Al'Ll <br />