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a^ f �NITORING WELL INSTALLATION REPOT <br /> Date: `1 ( �^ CONSTRUCTION f <br /> Premise Address: CJ- Total Depth <br /> Well No,: . LA_) Screen Length (from) .�7�. (to) S <br /> Filter Pack (from) (to) q <br /> Bentonite (from Ll (to) S <br /> Inspector: Grout (fro ) (to) <br /> Drilling rig type L i <br /> Permit No. Auger O.D. " �D.Completion - Stove pipe/ le one} <br /> Drilling Company: <br /> Driller: casing <br /> he+ght <br /> Consultant <br /> Geologist <br /> ABOVE-GROUND CHMM-SOX <br /> COhR'LETiON COMPI.ETICN <br /> SPECIAL PERMIT INFO Ground Sulxy <br /> Distance to sewer line > so grcut <br /> Domestic well on site -((y) n) ft. <br /> If yes, location and dist7n e - <br /> SAMPLING ... slarai <br /> Cn M <br /> Holding Temperature N r <br /> Method 4' 71 Pack <br /> ScreenIn Method 'EA = <br /> Tracking Sheet / n ) — <br /> �- fL <br /> SPOILS <br /> Storage Method _ ATERIALS EVELOPMENT <br /> Contamination Noted / t <br /> Storage Location - y GIM bmLd� rzma. 01 Z. asing type VC_- <br /> lank E ft. Screen 1 ft. <br /> lot size D <br /> GROUTING ; ags cement b <br /> uckets bentonite <br /> Depth to water . r_ a sand/gravel 10 E=f)92 <br /> Mix Ratios r -L iIt r Pack type/size..s <br /> Installation Method 0 urge Block: - ( y//fi?� �r _ <br /> Quantity Installed__.�JP_U „_: iscussed with geoWgist: - (y/ n ) <br /> EH 29 29 ype of method <br />