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01 rvIONITORING WELL INSTALLATION REPO <br /> Date: 5- Zoo CONSTRUCTION <br /> ^ NW <br /> Premise Address: 2Yll (i. DC n 2�pAcwl.t Total Depth <br /> L S Screen Length (from) (n5 (to) �_ <br /> Inspector:Well No.: Filter Pack (from) (to) <br /> Bentonite (from (to) <br /> Grout (from Z (to) O <br /> p Drilling rig type <br /> Permit No. < Y Auger O.D. 8 I.D. <br /> Drilling Completion - Stove pipe/christie box (circle one) <br /> Company: y!/�`��L�" <br /> Driller: -'Ala� casing <br /> height <br /> Consultant ,, � <br /> Geologist li//��ebl�/ `i <br /> ABOVEGROUND <br /> COMPLETION ISTY-80X <br /> C O <br /> SPECIAL PERMIT INFO. Grourd Surlwe <br /> Distance to sewer line 4— grow 3p <br /> Domestic well on site - ( yn <br /> If yes, location and distance - n. <br /> n. <br /> n. <br /> = m <br /> — o <br /> = m <br /> _ <br /> SAMPLING slotted ' <br /> uo5an = . <br /> Holding Temperature _ VIVO'P <br /> ack <br /> Method (_A-e _ <br /> Screening Method ✓�` _ <br /> Tracking Sheet -0 n ) <br /> SPOILS <br /> Storage Method t L- G� Ua` MATERIALS/DEVELOPMENT <br /> Contamination Noted - y n ) <br /> Storage Location Casing typ 7 V "4 <br /> Blank ft. Screen h. <br /> Slot size w <br /> GROUTING Bags cement_ u <br /> Buckets bentonite <br /> Depth to water -- Bags sand/gravel <br /> Mix Ratios /I -t- 90gJ Filter Pack type/size <br /> Installation Methodate/ Surge Block: - (y/ n ) <br /> Quantity Installed ? �aDc Q Discussed with geologist: - (y/n ) <br /> Type of method <br /> EH 29 29 <br />