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MONITORING WELL INSTALLATION REPORT <br /> Date:_ )-Z- �/� �oh CONSTRUCTION <br /> i <br /> Premise Address: Total Depth_ (,O <br /> Screen Length (from)_ <br /> Well No.: Filter Pack (from) K3, _(to) <br /> Inspector. Bentonite (from)_ q I (to) — — <br /> Grout (from) -0- (co) t£j <br /> Drilling rig type <br /> Permit No. I ( 7 Auger O.D. I.D.— <br /> Drilling I.D.- <br /> DrillingCom anCompletion - Stove pipe/cluistie box (circle one) <br /> casing <br /> I �–�7 heLght <br /> Consultant_ /-}-C-•� � `B �y ,�. <br /> Geologist 1r7 CJ66' *'n <br /> ��— ►T ABOVE-GRCUND CF-At5iY30X <br /> COt,PL EDON COM?LGt1CN <br /> SPECIAL PERMIT INFO. ��gUy <br /> {x <br /> Distance to sewer line T <br /> Domestic well on site - (y/ n) It. <br /> If yes, location and distance - <br /> . ft. <br /> h. <br /> M <br /> _ O <br /> SAMPLING <br /> soc'cn <br /> Holding Temperature <br /> Method_ <br /> Screening Method Pl D <br /> Tracking Sheet - (y/ n ) — <br /> ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contunination Noted - /n) <br /> Storage Location o'vx St (14 Casing type L ✓C _ <br /> Blank yS fc Screen----L!' f. <br /> Slot size . 0-2-0 <br /> GROUTING Bags cement /p <br /> Buckets bentonite <br /> Depth to water Bags sand/gravcl <br /> Mist Ratios_ I AvLj, A .il Filter Pack type/size 3 S"o+�' <br /> installation Method-! Surge Block: - (y/ , <br /> Quantity Installed 100tw— Discussed with geologist: - (y/(fi <br /> Type of method <br /> EH2929. . <br />