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i " <br /> MONITORING WELL INSTALd.ATION REP.,--cT <br /> Dace: /30 2O O3 CONSTRUCTION <br /> Premise Address: f {u (� (Na' 1 1 pp Total Depth F,� <br /> L Steen Lengrh (from) Cto) <br /> Well No.: �1 Filter Pack (from) (to) 4 I <br /> Bentonite (from) 3"S (co) <br /> Inspector. <br /> W D Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. LD- <br /> M,1ve Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> casing <br /> ` <br /> Dr ller. ���D <br /> heightConsul[an[ -V63nY\0. 17171 7 <br /> 1� <br /> Geologic[ � ` AgCVE�,gWNO <br /> CYALS"'!-30X <br /> SPECIAL PERMIT INFO. G`O Ci T-- <br /> r <br /> Jta.K <br /> Distance to sewer line <br /> Domestic well on site - ( y/ n ) ft. <br /> fyes, locadon and distance - 'L <br /> 3 <br /> s <br /> SAMPLING G✓ CIL /SI.. ,brtnd <br /> to ween _ <br /> �✓�..�5 = .,Huai"rade <br /> Holding Temperature = <br /> Method `' = <br /> Screening Method <br /> Tracking Sheet • C Y/ n ) <br /> — <br /> i{ <br /> SPOILS Ci� CLf 3L <br /> Storage Method <br /> MATERIALS/DEVELOPMENT <br /> Contamination Noted - C y .ny <br /> W ` Casing type <br /> Storage Location ql ` Blank Er. Steen IT- <br /> ' r size <br /> Bag <br /> GROUTING Bags cement <br /> to q Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Rados i Filter Pack typesize <br /> 20 Surge Block - C Y/ n ) <br /> Quantity <br /> Method 2 Discussed with geologist: - C Y/ n ) <br /> Quandry Installed Type of method <br /> 3� <br /> EH 29 29 WO Z10 - <br /> 5 `D <br /> 6 14 <br />