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'%wfONITORING WELL INSTALLATION REPOlIf <br /> Date: 6L L 1D CONSTRUCTION VV W l <br /> Premise Address: ' S o v, Total Depth -Z <br /> Screen Length (from) 2 (to) <br /> Well No.: -%4AL,*—, 1jF i�1 S Filter Pack (from) It Z <br /> I - Bentonite (from)_L'5' (to)� <br /> Inspector: `�vr�hM�j.ivwb.' Grout (from) % 1 (to) o <br /> Drilling rig type L-ku S <br /> Permit No. Auger O.D. to It I.D. R <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: -? L i`S i �h <br /> Driller: l 0±j 13;P k ) � h� casing <br /> �� IffT <br /> height , <br /> Consultant ;P <br /> ( w�eY <br /> Geologist •- <br /> ABOVE-GROUND C7�11STY-BOX <br /> CCNFLE'rnN <br /> SPECIAL PERMIT INFO, around Su fxw <br /> Distance to sewer line growl <br /> Domestic well on site - (y/ n ) 11 <br /> If yes, location and distance - n' <br /> x n. <br /> 1}�n. <br /> — m <br /> O <br /> O <br /> C <br /> SAMPLING dotted _ <br /> wS <br /> c4on <br /> Holding Temperature _ vava4 pack <br /> Method <br /> Screening Method <br /> Tracking Sheet <br /> tti n. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) / <br /> Storage Location i Casing type <br /> Blank 131 % ft. Screen {o ! "�ft. <br /> Slot size OW <br /> GROUTING Bags cementLt tj"r <br /> Buckets bentonite �P <br /> Depth to water Bag�sanravel D 4 <br /> Mix Ratios !6oan-,r5w4aln.g •V'> -VI'( Filter-- acktype/size %-Jm- <br /> Installation Method_ o lw r> Surge Block: - ( y/ n ) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />