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MONITORING WELL INSTALLATION REPORT <br /> Date: - Z Z.. 6Z� CONSTRUCTION <br /> Premise Address: k ,:� Total Depth <br /> Screen Length (from) .3 (to) c5` <br /> Well No,: YY�tom` Filter Pack (from)_ 3 ato <br /> ( ) <br /> _ Bentonite (from) -30's-'(to) �a•� ' <br /> Inspector- Grout (from) (to) <br /> �� Drilling rig type <br /> Permit No, 71 Auger O.D. I.D. - <br /> ��� i� Completion - Stove pipejcluistie box (circle one) <br /> Drilling Company: k�2&� <br /> casing <br /> - 1 <br /> he, <br /> Consultant t�T ` 4 t' ' V <br /> Geologist 94A,1 'I �, s # <br /> s -4 <br /> ABOVE-GIICUNO C}�iSSiY-aQX <br /> WtiPt..rz I'1Ul4 CCk�+iPL�T3C;N <br /> SPECIAL'PERMIT INFO. � - ,. d�oeraet�8ts� +� <br /> Distance to sewer line proof <br /> Domestic well on site - (y j n} 4 <br /> If yes;location and distance - - .� '.� . ! ..ft. <br /> SAMPLING - 74. <br /> tior:vtii <br /> Holding Temperature , saccn <br /> Method k ; �. <br /> 4 C. ( ../t .tsA.r2R ¢avWft <br /> Screening Method <br /> Tracking Sheet -�j n) <br /> SPOILS t s - - �. ,x" ft. <br /> " <br /> Method <br /> Storage ` <br /> Contamination Noted - ... MATERIALSjDEVELOPMENT <br /> n ) � <br /> Storage Location <br /> ( Casing type_ <br /> i Blank ` %4r ft- Screen_ j2 ' ft. <br /> r Slot size. , r)7-0 <br /> GROLRTNG 7 . Bags cement <br /> Buckets bentonite_ 1 , <br /> --Depth to water <br /> Mix Ratios r Bags sand/gravel— i <br /> Installadon MethodFilter Pack typejsize <br /> {quantity Installed r' 1e / ---�' Surge Block: - (y j u -- <br /> Discussed with geologist: -'(y j <br /> EH 29 29 ' , - - ",- Type of method <br />