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MONITORING WELL INSTALLATION REP <br /> Op� ` <br /> Date: ,' 1( It CONSTRUCI'EON' <br /> 'Premise Address: Total Depth <br /> 5 <br /> :k. S een Leri Froin ZD <br /> Well •`/ kk� �u5 g [ ) (to) U <br /> No.. T.'//} �J nlAv a rt v►.st�tet Pack (from) Lo <br /> to <br /> �-f�' V vM. 1, <br /> Inspector: ."•`� r.._� Bentonite� 4`(from)_� �(to) <br /> Grout (from) <br /> -(to) <br /> Drilling rig type <br /> Permit No. Auger Q.D. I.D. <br /> Completion - Stove pipe/chox e one) <br /> bcircl <br /> Drilling Company: V �!� { ) <br /> Driller: _ <br /> ca'sinq <br /> .4 height 0 <br /> Consultant I A <br /> Geologist <br /> ABOVE.-GROUND cttisrr aox <br /> CC1.���N <br /> SPECIAL PERMIT INFO — — COMPLETa.Q <br /> G=nd Surface <br /> Distance to sewer line Qra�t <br /> Domestic welt on site - (y/ n ) <br /> yes, location an 7 <br /> t` Y � d distance - <br /> _ L <br /> SAMPLING a <br /> :lo tied c <br /> Holding Temperature <br /> Method = gavel pack <br /> Screening Method <br /> Tracking Sheet-- ( y/n ) — <br /> SPOIiS d b' <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - [y/ n )' <br /> Storage Location Casing type <br /> Blank t b ft. Screen 1 D ft. <br /> Slot size ,y <br /> GROUTING Bags cement <br /> Buckets bentonite <br />' Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Metho Surge Block: - ( y/�) <br /> Quantity Installed Discussed with geologist: - (rp/ n ) <br /> EH.29 29 Type of method <br />� J <br />