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MONITORING WELL INSTALLATION REPOrn f <br /> Date: 3 'i 3 'O{•p <br /> CONSTRUCTION <br /> Premise Address: 3q(p Total Depth iQ <br /> Screen Length (from) (to)-�p <br /> Well No.: Filter Pack (from) Lj (to) <br /> Bentonite ^ <br /> LB <br /> Inspector: (frame- - � •• (t°)—I fa <br /> Grout <br /> (to)� <br /> Permit No. ��'9 - 46 <br /> Drilling rig type � <br /> Auger O.D. M I.D. G <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company._ � itc.dL— <br /> Driller: <br /> casing <br /> Consultant / <br /> t height <br /> Geologist /1 T <br /> ABOVE-GROUND <br /> COMPL.E DN CHRMTYWX <br /> SPECIAL PERMIT INFO. Grourd SurfaceCOMPLET]ON <br /> Distance to sewer line Oros <br /> Domestic well on site - y n ) <br /> If yes, location and distance - <br /> 2-9* [� tt. <br /> r <br /> SAMPLING <br /> slotted c <br /> taCJQft <br /> Holding Temperature <br /> dA nle <br /> Method <br /> Screening Method <br /> Tracking Sheet - ( y/ n4. <br /> } <br /> �P 0 <br /> SPOILS <br /> Storage Methods nA V"L,4 MATEPdALSIPEVELOPNCNT <br /> Contamination Noted - 67 n ) <br /> Storage Location OV to,., Iw�-�► Casing type -- 3tt r 1 N) n c— <br /> Blank 7-0 ft. Screen W 10 ft. <br /> Slot size2-16 <br /> GROUTING Bags cement. <br /> Buckets bentonite Z ! <br /> Depth to water "fad Bags sand/graveI <br /> Mix Ratios -r Filter Pack type/size. l•- 3 <br /> Installation Method Surge Block: - (y n <br /> Quantity Installed SVAO Discussed with geologist: - ( � <br /> Type of method <br /> EH 29 29 <br /> 3-I4--o J -?� <br />