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1-MONITORING WELL INSTALLATION REP" 7 <br /> � � I <br /> Date:` } _ "- -� CONSTRUCTION <br /> Premise Address: Total Depth 0 I <br /> I z Screen Length (from) o (to) r0 <br /> ,1 _ <br /> { Well No.: 21P.�t &J L!','.&W IV S:.� Filter Pack- (from) (to) j�k <br /> Bentonite (from) —(to) <br /> Inspector: 4L*.—Iq }� * • -Grout'4' ,, - - (fro } = S t ,�(to) <br /> + - _ _ Drilling rig tYP <br /> Permit No, 'Auger O.D. i� k * I.D. ' <br /> ;,. Drilling Company: <br /> Lll� _ M{Completion - Stove pipe/cluistie box (circle one) <br /> Driller: casing <br /> F - "height <br /> Consultant <br /> Geologist -�'"• ► <br /> -4 ABGYE-GRCUND <br /> N , 00WIP ETJON GWMM-80X <br /> SPECIAL PERMIT INFO. ;.. '- 06und Suriawcs ++ ...�.......� ` <br /> Distance to setter Brie' •j`4 a ;�- Y ori <br /> Domestic well on site (y/ri ) <br /> If yes, location and distance - <br /> 4 r °ft. <br /> = SAMPLING •Iar.+hi <br /> Holding TemperaturegU <br /> Method <br /> Screening Method rte s ► <br /> _ 'Tracking Sheet - { j n ) <br /> _ mit. M — b tL <br /> SPOILS <br /> Storage Method MATERIALSLDEVELOPMENT <br /> -Contamination Noted= (y! ' <br /> A <br /> Storage Location Casing type fit' t <br /> Blank 46 fL" Screen <br /> Slot size 0-62o <br /> GROUTING Bags cement ' <br /> Buckets bentonite <br /> Depth to water �' _ Bags sand/gravel 6 <br /> Mix Ratios ct^. .7b Filter Pack type/size 74 rt <br /> Installation Method_ �', . ^ _ Surge Block. - (y/i ) <br /> Quantity Installed Discussed with geo ogist: - / n) <br /> Type of method <br />