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~MONITORING WELL INSTALLATION REPT <br /> Date: ' ' 7 • / I CONSTRUCT'O_ N <br /> Premise Address: rALT.51— @ Total Depth <br /> nn Off la' creen Len,'::. (from.) 3, (to) 43, <br /> Well No.: M ' n Filter Pack `frc.-. (to) 40.to <br /> • �� �� � Bentonite C -en.) 0,�_(to' 38•(o <br /> Inspector• Grout (from) 'fir <br /> Drilling rig ':• <br /> Permit No. �1 x/ Auger O.D. I.D. <br /> - _ <br /> Completion Stove pipe/ tie box (circle one) <br /> Consultant <br /> Geologist u- d7(MGI.i?v l� , +klaup <br /> l. 5 /. 2�j <br /> SPECIAL PERMIT INFO. ABOVE-GROUND CHRISTI SOX <br /> Distance to sewer line L , COMPLETION COMPLETION <br /> Domestic well on site - (yn ) Ground Stvlac� <br /> If yes, location and distance <br /> - I <br /> grout <br /> ft. <br /> n. <br /> = o <br /> SAMPLING <br /> J — c <br /> 0 <br /> Holding Temperature sloe = E <br /> Method aecion — <br /> Screening Method K — '. gravel pack <br /> Tracking Sheet - (y/ n) =_ <br /> ft. — ft. <br /> SPOILS <br /> Storage Method DC-) MATERIALS/DEVELOPMENT <br /> Contamination Notes - (y/ ) 4 <br /> Storage Location � 47CA A&v-n $EeWKc$ Casing 14- 5G� <br /> /ikrta7i� ell GPO,/ -""4-t 1 . Blank q4• ft. Screen ft. <br /> Slot size 0 . 020 <br /> Bags cement <br /> GROUTING Buckets bentonite <br /> Bags sand/gravel <br /> Depth to water Filter Pack type/size 2 /z <br /> Mix Ratios CK NZ/ Surge Block: - y n ) <br /> Installation Method k4m P rzmDiscussed with eologist: - (Cq n ) <br /> Quantity Installed Type of method S14-y �� <br />