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0 <br /> MONITORING WELL INSTALLATION REPOR <br /> Date: 7l 2z/ CONSTRUCTION <br /> / , I Total Depth APremise Address: �� `�w`� �'° Screen Length (from) (to) ' <br /> Well No.:Al w1t y Filter Pack (from) 0 —(to) f <br /> Bentonite (from) I`( (to) L <br /> Inspector: Grout (from) ('L- —(to) <br /> r Drilling rig type <br /> Permit No. Auger O.D.—_ 1, " I.D. 1p'' <br /> Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company: <br /> casing <br /> Driller: he=ght <br /> Consultant JLm S <br /> Geologist ABOVE-GRCUN <br /> C4•SiSTY-30X <br /> COMPI..�T C-O P EEMCN <br /> SPECIAL PERMIT INFO. Grourd Surfacs <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - (y/ n ) ft. <br /> If yes, location and distance - ft. <br /> _ N <br /> C <br /> SAMPLING slot-ld = c <br /> socicn =_ � <br /> Holding Temperature <br /> Method _ <br /> Screening Method <br /> Tracking Shcet - (y/ n ) <br /> 7 ,• — <br /> ti. J ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVEI.OPMENT <br /> Contamination Noted - (y/ n ) Casing type Z „'vim <br /> Storage Location Blank 17 fr- Screen 2a ft. <br /> Slot size D- 0 ZA <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> �2r Bags sand/gravcI <br /> Depth to water, Filter Pack type/size ' <br /> Mix Ratios n Surge Block: - ( y <br /> Installation Method Discussed with geologist: - ( y/ n ) <br /> Quantity Installed _ <br /> Type of method <br /> EH 29 29 <br />