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MONITORING WELL INSTALLATION REPOI%Iof <br /> Date: � �J CONSTRUCTION <br /> Premise Address: 7�Y y PSS"" 7 / A^ Total Depth �0 <br /> Screen Length (from) (to) <br /> Well No.: 5 Filter Pack (from) (to)� <br /> Bentonite (from) (to)3q <br /> Inspector. Grout (fro ) (to) uw <br /> C` Drilling rig type (fS <br /> Permit No. 1 ©3 ! Auger O.D. -V1 L, I.D. f1 i <br /> Completion - Stove pipe/cltristie box (circle one) <br /> Drilling Company: �iltQ�4JAI � <br /> Driller: R04 V casing <br /> /Ci4 <br /> Consultant f� he_ght <br /> Geologist T�titb-- 1�� r✓ C <br /> ABOVE-GRCUND EiJAtgTY$OX <br /> COMPLETION COMPLETICN <br /> SPECIAL PERMIT INFO. Ground Su l <br /> Distance to sewer line f <br /> Domestic well on site - (y <br /> If yes, location and distance - ft. <br /> Ott. <br /> SAMPLING Sv slatted c <br /> YY &*dcn R• — <br /> Holding Temperature y oc <br /> Method U AoAo7UI�r <br /> Screening Method P 1 D _ <br /> Tracking Sheet (yy n ) <br /> M <br /> SPOILS <br /> Storage Method ami c MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( n) <br /> Storage Location Casing type <br /> Blank---J-2—ft. Scree ft. <br /> Slot size 1010 <br /> GROUTING Bags cement <br /> Buckets bentonite 2.5 <br /> Depth to water Bags sand/gravel FJ – 3 1 ID <br /> Mix Rados J( Filter Pack type/size $ <br /> Installation Method Surge Block: - ( y AO) <br /> ) <br /> Quantity Installed > Discussed with geologist: - (0/ n ) <br /> Type of method <br /> EH 29 29 <br />