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MONITORING WT.0 INSTALLATION REPORT <br /> Date: <;L 1Z-!> 1 0 0 CONSTRUCTION <br /> Premise Address: V15) Total Depth <br /> Well No.: Screen Length (from) It< (to) <br /> 7dA "a— Filter Pack (from) 2 3 (to) <br /> Bentonite (from) (to) <br /> Inspector- 1`.5a...+ r Grout (from) to <br /> Drilling rig We <br /> Permit No. 7---r-5 <br /> —5)fZ—C) Auger O.D... ­_In I.D. <br /> Drilling Companr. Completion - Stove pipe/christie box (circle one) <br /> Driller...... <br /> 'Fcasing <br /> Co.nsultanr TF71 'r height: <br /> I IT <br /> Geologist 14An 4 —QV-T <br /> AllVE-GROUND <br /> CONPLETCN C4_SiSTY_30X <br /> SPECIAL PERMIT INFO. COMPL-EMCN <br /> Distance to Sewer line orcut <br /> Domestic well on site - (y n) <br /> It yes, location and distance - ft. <br /> 2 <br /> A5 <br /> SAMPLING <br /> Holding Temperature <br /> Screening Method <br /> Tracking Sheet n <br /> SPOILS <br /> Storage Method............... rjy, (A a_0 r- MATERfg§�2EVELOPMENT <br /> Contamination Noted - y n <br /> Storage Location_ Casing type <br /> Blank 3 _f r- Screen_ <br /> �qlkounNG Slot size 7 0 <br /> Bags cement <br /> Depth to water 17� Buckets bentonite <br /> Bags sand/gravel <br /> Mix Ratios 1—- —.1 --- I <br /> 0 Filter Pack type/size <br /> Installation m th 0'Y^_-A A <br /> Quantity Installed 'LAA­ U ne Surge Block: - ( y 0 <br /> _f4JA,�, 0% It Is Discussed with geologist: - y <br /> EH 29 29 A-/ Type of method <br />