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M <br /> MONITORING WELL INSTALUkTION REPORT <br /> 3 <br /> Date: <br /> CON <br /> STRUCT'ION <br /> 3 r <br /> G Total Depth 07, <br /> Premise Address: 10 3 0 v Screen Length (from)---7-5- (to) _ <br /> Well No.: Filter Pack (from) :—(to) <br /> Bentonite (from) (to) <br /> r Grout (from) 45-6_=(to) r-f <br /> Inspector. i Drilling rig type <br /> Permit No. D D sfe 3 2 e Auger O.D. 2I.D. <br /> Completion - Stove pipe/christie box <br /> (circle one) <br /> Drilling Company: r <br /> er: ! Ye a <br /> casing <br /> Drillheight <br /> . � � <br /> Consultant iznn - ^�- <br /> - T <br /> M Geologist P a 11F�JYT=-GRCUND <br /> �t�VRsoN COMPLEMN <br /> C*03ZTY_80x <br /> SPECIAL PERMIT INFO. Gfourd Stxfwt <br /> Distance to sewer line <br /> Domestic well on site - (y/ n) tt. <br /> If yes, location and distance - 5 3. , tt. <br /> ut/+,� C2� C4-We d ff�'li e o� <br /> SAMPLING - `�- t Gd'0 f' j/Lfd `N2� L�C µ a <br /> M LJei'+f/vi' �d D iIt Gls�is���r� t IwoJ r %sot�cn <br /> ." <br /> Holding Temperature 6 Cry: VJ 73Y'aPack <br /> Method e G <br /> Screening Method P .D -k <br /> Tracking Sheet (y/ n ) <br /> SPOILS Aotl. _`� <br /> Storage Method MATERIALS LAPMENT <br /> Contamination Noted - (y/n) <br /> Storage Location Casing type <br /> BlankS� ft. Screen 44 ft. <br /> Slot size <br /> GROUTING Flags cement <br /> Buckets bentonite <br /> Depth to water rIJr Bags sand/gravel <br /> Mix Ratios I 3SA41/r►�, Filter Pack type/s ze <br /> Installation Method J Hi-° :Surge Block: - (f n ) <br /> Quantity Installed Discussed with geologist: - C& n) <br /> Typeof method <br /> EH 29 29 � ,, /h� -- PU•r c. c[� m�,`v rh �J <br />