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�-MONITORING WELL INSTALLATION REP"e <br /> Date: �� ' �Z/ CONSTRUCTION <br /> Premise Address: /�iC�IGE� S✓ 1cz� $Cf�(i1 Y3C IL, Total Depth 7 <br /> Screen Length (from) 6,'L- 7 (to) 42.-7?— <br /> Well <br /> 2.7Well No.: MI 5 Filter Pack (from) CIT -F, <br /> (from) 39••0- (to) 37.S <br /> Inspector: Grout (from) 37.S (to) 6 <br /> Drilling rig type <br /> Permit No. Auger O.D. 2. 2S <br /> Completion - Stove pip c 'stie box (circle one) <br /> Consultant <br /> Geologist 61U— Ol.tn2-LZ, a Ts+kk++P <br /> VVI <br /> ♦T T <br /> SPECIAL PERMIT INFO. ABOVE-GROUND <br /> CNA15Tl'480X <br /> Distance to sewer lineL J�r COMPLETION COMPLETION <br /> Domestic well on site - ( y c) Ground S <br /> If yes, location and distance - PIZ <br /> grout <br /> n. <br /> n. <br /> ' tt. <br /> — m <br /> SAMPLING <br /> _ o <br /> Holding Temperature slotted Z• B <br /> Method t°CB0" _ <br /> Screening Method <br /> Tracking Sheet - (y/ n) <br /> SPOILS <br /> Storage Me_ od p/f�.s MATERIALS/DEVELOPMENT <br /> Contamination Notes - (y/ <br /> n <br /> Storage Location )JjfjL) TD Casing type <br /> Blank L.7s ' fL Screen _ 2,() ft. <br /> �75YL✓G� Lir )0Jt✓':r" C—V "r <T�",'j Slot size 0•U/0 <br /> S Bags cement A"s <br /> GROUTING Buckets bentonite 2 LSt�c[LFES <br /> a c Bags sand/gravel <br /> Depth to water b . G �� J �+ f��- Filter Pack type/sizes 2 Z <br /> Mix Ratios f D l Surge Block: - (y np <br /> Installation Method � -0 Discussed with geo ogist: - ®/ n ) <br /> Quantity Installed Type of method <br />