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MONITORING WELL INSTALLATION REP. KT <br /> boy - o©0 Z p u q <br /> CJ Zoo l �t 1 I� CONSTRUCTION <br /> Date: <br /> 2 C.1 C Total Depth ` C <br /> ?remise Address: � Screen Length (from) <br /> ` ,� Filter Pack <br /> Well No. : Benronire (from) Z Z (to) 2 't <br /> Grout (from) L 'L (to) -r�* <br /> Inspector. J ({� � Drilling rig type <br /> Perini[ No. d $ p i I Auger O.D. I-D. <br /> SCompletion - Stove ptpe/chrnstie box (circle one) <br /> Drilling Company: 9 <br /> casing <br /> Driller. Ll(/ ��li� 9 �� _ 7r7T heLghc { <br /> Consultant <br /> w <br /> Geologist hv� l� aA�9 ABCVE-GACUND CFFMI-y-gCX <br /> CC&P!ETON CpMpLE71CN <br /> J} 6 /Q <br /> Ground Sutad <br /> SPECIAL PERMiT INFO. I <br /> grout <br /> Distance to sewer line •L238 <br /> t <br /> Domestic well on site - ( y fL <br /> If yes, location and dis e N <br /> S U ( .wnaa <br /> SAMPLING sac=od <br /> - <br /> Holding Temperature — <br /> Method_ <br /> Screening Method < -_ <br /> Tracking Sheet - C Y / n ) <br /> SPOILS <br /> Q MA /DEVELOPMENT h <br /> Storage Method rA <br /> Contamination Noted - ( y Cas• g type <br /> Storage Location � n 1n 1 I 1 Bl Screen _fL <br /> Slo size <br /> UTING IV� Ba cement <br /> GRO <br /> IV Bu es bentonite <br /> f� Ba sack type/ <br /> ravei <br /> Depth to water V 1 ` `� Fi Pack typelsize <br /> Mix Ratios S e Block: - C y / n ) <br /> Installation Method C�i✓ Dcussed with geologist. - C Y / a ) <br /> Quantity Installed T e of method � J <br /> EH 2 <br />