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i <br /> t�OINITORING WELL INSTALLATION REPO <br /> k . <br /> Date: 0 Z CONSTRUCTION f <br /> Premise Address: , Total Depth <br /> Screen Length (from) O" (to) ---?0 � <br /> Well No.: 42 Filter Pack (from) _4�"o (to)_, � <br /> Bentonite (from) (to) 2 <br /> Inspector: �dLS ' Grout (from) L (t0)42Lae- e� <br /> Drilling rig type <br /> Permit No. Auger O.D. 0'r <br /> " Completion - Stove clu istie bo (circle one) *� <br /> Drilling Company: 1/110 P1 <br /> Driller: e57 casing <br /> W- „- F height <br /> Consultant <br /> Geologist M <br /> - w .:4. ABOVE-GRCUND �}¢�1S'TY-80X <br /> COWL.E C14 COMPLEnON <br /> SPECIAL PERMIT INFO. - " - Ground Sia <br /> Distance to sewer line_ -�� / n - grout <br /> Domestic well on site (y i rT�i z 6! ft. <br /> If yes, location and distance - <br /> tt. ' <br /> SAMPLING Mot"secdcri <br /> Holding Tem era a 97"1 Pack <br /> 4' <br /> Method7,77 <br /> s= <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> SPOILS <br /> Storage Method 5 MATERIALS EVELOPMENT <br /> Contamination Noted - ( <br /> Storage Location o eL a1' .. �, Casing type J` a -0 0 U ti <br /> Blank Screen,,76 <br /> - Slot size C92 1 <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water ' ca7 'l Bags sand/gravel, S .� <br /> Mix Ratios_ Filter Pack type/size <br /> Installation Method Surge Block: - ( y4 <br /> Quantity Installed - Discussed with geologist: - <br /> Type of method <br /> EH 29 29 <br /> ol3 �y � <br /> 44 tv <br />