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9 <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: Ith X CONSTRUCTION <br /> 2 <br /> 3 <br /> Premise Address: <br /> 3 /U 't)t"Y�'4 fi� Total Depth D <br /> � ( Screen Length (from) SS Ro) 7� <br /> Well No.: 'J� ��l C t `� (� Filter Pack (from) 5` (to) 7d <br /> Bentonite (from) S& (to)S3 /� <br /> Inspector. /��� Grout (from) "I., (to) S AL r <br /> Drilling rig type <br /> Permit No. Auger O.D. 3'% I•D• <br /> Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company: <br /> casing <br /> Driller: height <br /> Consultant <br /> J/ C� <br /> Geologist !/ � �c t kpyE.GRCUND \ <br /> COWLE71ONGrou <br /> C}¢ Sf130X <br /> CCMPI_R1CN <br /> SPECIAL PERMIT INFO. semi Suiac� <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - (y/ n) It. <br /> If yes, location and distance - tt- <br /> R. <br /> _ M <br /> C <br /> 1IOr➢j <br /> SAMPLING <br /> Holding Temperature <br /> Method <br /> Screening Method <br /> Tracking Shcet - (y/ n) <br /> �/ tt• = tt. <br /> Sall 6 / //ko /+ <br /> -�lf'1T�1 <br /> SPOILS Gut �rtle �r 7�v1�� <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted- (y/ n ) r/ <br /> Storage Location Casing type Z —fi <br /> Blank ft. Screen <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel K 3 <br /> Depth to water Filter Pack type/size <br /> Mix Ratios Surge Block: - (y/tt ) <br /> -\Installation Method Discussed with geologist: - (y/ n) <br /> Quantity Installed Type of method <br /> EH 29 29 <br />