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MONITORING WELL INSTALLATION REPORO <br /> Date:_ 7//2- / CONSTRUCTION <br /> Premise Address: Xk6 7 7 cj y Total Depth LSO <br /> Well No.: at !AJ —3 Screen Length (from) 4,w'3r(tO)7'r— <br /> Filter Pack (from)_ V9 ' (to) /3 <br /> Inspector: Set v y Bentonite (from) (to) <br /> Grout (from) o (to) <br /> Permit No, <br /> ?'V L Drilling rig type <br /> Auger O.D. 'e I.D. <br /> Com a Ill cluistie box (circle one) <br /> Drilling Company:��o/�t,�n <br /> Driller: fOYL�/ casing <br /> -��r--- he±qht <br /> ConsultantyAGdp$-avl <br /> Geologist_ C_ J7Y�ln 0�� ti <br /> ABCVEGROU <br /> COMP N CHRSTY-80x <br /> SPECIAL PERMIT INFO. Ground Sudan CCMPLETICN <br /> Distance to sewer line gran <br /> Domestic well on site - ( y/ ) <br /> If yes, location and distance ft. <br /> eft. 13 ft. <br /> — e <br /> = m <br /> = e <br /> SAMPLING = <br /> 0 <br /> t1oC,ad — `c <br /> axicn '- <br /> Holding Temperature = <br /> Method 1 _ = gnvd pads <br /> Screenin; Method _ <br /> Tracking Sheet - ( y/ n ) <br /> y� <br /> R• — — ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT Noted <br /> Storage Location Casing type 2/' -75 �e �(�G <br /> Blank __ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement_ Z Z <br /> Buckets bentonite / <br /> Depth to water y Bags sand/gravel <br /> Mix Ratios_'z. �/ ,r n Filter Pack type/size <br /> Installation Method_ � 17 Surge Block: - (y/�) <br /> Quantity Installed z a/p Discussed with geologist: - (y/ n ) <br /> EH 29 29 Type of method <br /> ld I` <br /> 75 <br />