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MONITORING WELL INSTALLATION REP—e-T <br /> Date: u CONSTRUCTION <br /> o�.emA se Address: W V ' L v"_ 'dotal Depth � - <br /> - <br /> S�eea Length (from) (to) 46 <br /> Well No.: Filter Pack Cfrom} Cto) <br /> Bentonite (from) (to)�[{i <br /> Inspector. Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I-D. <br /> Completion - Stove pipe/cnristie box (circle one) <br /> Drilling I Company <br /> Driller. � Cas lag <br /> '19 <br /> Consultant -A 6) <br /> ♦ 7 T <br /> Geologist ASCV=--GRMN0 <br /> CCW!SCAN <br /> C.—AAA=-1 Cts! <br /> SLrf <br /> SPECIAL. PERMIT INFO. Ground 'c* <br /> s ' <br /> Distance to sewer 11ne <br /> Domestic Well OCA site - n ) --�� - <br /> If yes, location and dis ce - 7- <br /> _ O <br /> SA62LING a <br /> wean - <br /> Holding Temperature 72vw pack <br /> Method <br /> Screening Method <br /> Tracking Sheet - ( y/ n ) — <br /> IL ♦ » = tt. <br /> SPOILS <br /> Storage Method Mj�TERIALS/DEVEL.OPM= <br /> Contamination Noted - (y/ (r f v <br /> Blank <br /> Storage Location CasingPefL <br /> fn Screen <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gype/ <br /> Mix Ratios Filter Pack tyge/siWor- <br /> J <br /> Installation Method Surge Block: - (yQuanriry Installed Discussed wizlz ge { � a) <br /> Type of method <br /> EH 29 29 <br />