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e •I <br /> MONITORING WELL INSTALLATION REP-r(T <br /> Date: Sr �9 b6 CONSTRUCTION <br /> ?remise Address: k I -471 Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> !-0 fQ� Bentonite (from) (to) <br /> Inspector. 1� � � `� Grout (from) (to) <br /> Drilling rig type <br /> Permit No. �CL 1 Auger O.D. I.D. <br /> Completion - Stove pipe/duistie box (circle one) <br /> Drilling Company: <br /> Driller- 6 Tcas i.ng <br /> T height <br /> Consultant U-5 r V <br /> Geologist_ t — <br /> ABCVE-GACUNO <br /> CC NF--TAN C}-McCX <br /> C�1PL=PLE i iCN <br /> SPECIAL PERMIT INFO. Grain Suf'c' <br /> r ' <br /> Distance to sewer line I PZ1 gra2 <br /> Domestic well on site - ( y/ n } 1 I <br /> If yes, location and distance - �- <br /> _ _ 3 <br /> 3 <br /> a <br /> — Q <br /> SAMPLING :ioctnd = a <br /> wccn - — <br /> Holding Temperature =j „vi r arc <br /> Method `I <br /> Screening Method — <br /> Tracking Sheet - ( y/ n ) <br /> tL <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type <br /> Blank fn Screen _fr <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n ) <br /> Quandry Installed Discussed with geologist: - ( y/ n) <br /> Type of method <br /> EH 29 29 <br />