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sr , <br /> iONITORING WELL INSTALLATION REP <br /> Dater ? )����<< CONS UCTTON <br /> Premise Address: ;�Q l b/ aj, !' 17i Total Depth 114' <br /> Screen Length (from) (to) <br /> Well No.: G c-' �' w Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: �� Grout (from) (to) <br /> Drilling rig type <br /> Permit No.S a (9&3-�2 3 ip <br /> I.D. <br /> e/clu istie box (circle one) <br /> Drilling Company: �� <br /> Driller: <br /> Consultant W �I Geologist CHR*'TY-80X <br /> E , COWLEMCN <br /> SPECIAL PERMIT INFO. Ground Su lwo <br /> Distance to sewer line of out <br /> Domestic well on site - (y/ n ) ft. <br /> If yes, location and distance - <br /> �. ft. <br /> 0 <br /> SAMPLING <br /> a*c1cn <br /> Holding Temperature F <br /> Method <br /> Screenin;Method c — <br /> Tracking Sheet - (y/ n ) _ <br /> ft. = ft. <br /> SPOILS <br /> Storage Method MA RIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) <br /> Storage Location Cas' <br /> pe <br /> Blaft. Screen ft. <br /> Slot <br /> GROUTING Bag <br /> Buckets b tonite <br /> Depth to water �U Bags sand/ ave <br /> Mix Ratios Filter Pack /size <br /> Installation Method Surge Block: / ii ) <br /> Quantity Installed Discussed wit eologist: - ( y/ n ) <br /> Type of metliod <br /> EH 29 29 <br />