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MONITORING WELL INSTALLATION REP0 <br /> Date:_=\ IT I �� ( CONSTRUCTION <br /> Premise Address: WAI>Vva O Total Depth <br /> 1 lJO �� • ate` <br /> r 1 Screen Length (from) (to) <br /> Well No.: VV\ ' _ Filter Pack (from) (to) <br /> IQ Bentonite (from) (to) <br /> Inspector. S CU VY' Grout (from)_(t0)- <br /> Drilling <br /> from) (to)Drilling rig type 9c, <br /> Permit No. S�L a1-J Auger O.D. I.D. <br /> Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company: I"�1�oA'{- t'Cr�� � �r <br /> Driller: � I casing <br /> nn`` // <br /> height <br /> Consultant 'I-n <br /> Geologist C� _ <br /> ABOvE.GRCUND CH RZ_rY-a0X <br /> COI.FLFrCN comn-TION <br /> SPECIAL PERMIT INFO. G=rd Stat <br /> prom <br /> Distance to sewer line <br /> Domestic well on site - (y/ n) tt. <br /> If yes, location and distance - ft. <br /> ft. <br /> 0 <br /> SAMPLING slorad <br /> tocicn <br /> Holding Temperature P-4k <br /> Method <br /> Screening Method = <br /> ^ _ <br /> Tracking Sheet - ( y/ n ) fix. <br /> ft. = ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) _I� Qy r <br /> Storage Location Casing <br /> ank type.t {t. Screen ft <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/n ) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />