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EPODaNITORING WELL INSTALLATION REPO- <br /> Date: <br /> te:� G�' T CONSTRUCTION <br /> Premise Address: � /` / Total Depth P570 <br /> Screen Length (from) 2710 (to) <br /> M ���J Filter Pack <br /> Well No,: (from) ZCo) <br /> Bentonite (from) (to) 7—Ly <br /> Inspector: , �2 �� H Grout (from)e?1L (to) b <br /> Qp Drilling rig -type <br /> Permit No. �0�Oa� Auger O.D._ I.D. <br /> / Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: V <br /> � g t <br /> Driller: he <br /> heigghht <br /> Consultant HVSCo DUNS <br /> Geologist 's ABOVE GRCUNO <br /> COKVLEf1ON pVAPLEMON <br /> ,COMPLETION <br /> SPECIAL PERMIT INFO. t �-� Su ixa — <br /> prcut <br /> Distance to sewer line <br /> Domestic well on site it, <br /> If yes, location and distance - ft. <br /> _ <br /> O <br /> SAMPLING elorcd <br /> tsr cn <br /> Holding Temperature = gav'�Dw <br /> Method — <br /> Screening Method = <br /> Tracking Sheet - ( y/ n ) r '; <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) <br /> Storage Location Casing type 7[A <br /> Blank ft. Screen 2d h• <br /> Slot size OBD <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water N Bags sand/gravel ]� <br /> Mix Ratios U- 2f <br /> GOhJ 1�y0 Filter Pack type/size 9 17 <br /> Installation Method � Surge Block: <br /> Quantity Installed Discussed with geologist: - ®/ n ) <br /> Type of method <br /> EH 29 29 <br />