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f MONITORING WELL:INSTALLATION REP. <br /> 3 <br /> CONSTRUCTION <br /> Date: <br /> Mn �[f/Q?remise Address: O q V 7 ' 9_ Toral Depth <br /> Screen Length (from) 5 (to)• S <br /> Filter Pack (from) (to) <br /> Well No.: 3 6 <br /> Bentonite (from) S`} (to) 6 <br /> Grout (from) <br /> [nspector o (to} <br /> Drilling rig type <br /> Permit No. z 65k). Auger O.D. <br /> o1.D. <br /> CompCompletioni <br /> Stove pp e/christie box (circle one) <br /> Drilling Company: <br /> �'� k ars Y <br /> Driller U carrot <br /> /, �� height Z <br /> Consultant l 1I rculld + 7 <br /> Geologist an A,BQVE-GROUND <br /> GyIrPL='TiGN CHSLSTY-30X <br /> C.OMPI=CN <br /> SPECIAL PERMIT INFO. Grained Surface <br /> Distance to sewer line grout <br /> Domestic well on site n ) '-.`L <br /> If yes, location and dis ce - fi r -fL <br /> SAMPLING . ���.. 1I. Z,�-Z rl 0 � — <br /> art <br /> Holding Temperature <br /> g2vw Pack <br /> Method I <br /> Screening Method f D 4 p <br /> Tracking Sheet - ( y/ a) =.2 <br /> SPOILS ' <br /> Storage Method �/ ! r C MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/�} E! V <br /> Storage Location Casing type <br /> Blank ft. Screen ; CO ft-. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water / Bags sand/gravei. 4 <br /> Mix Ratios j Filter Pack typ size <br /> Installation Method `� Surge Block: - (//.In ) } <br /> Quantity Installed Discussed wi eulogist: - y n <br /> Type } 1� <br /> T e of method <br /> EH 24 24 a <br /> i <br /> 4 <br />