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t A r) <br /> '`'MONITORING WELL INSTALLATION REPURT <br /> Date: 161d <br /> 6 , d 1 CONSTRUCTION <br /> Premise Address: �l W 9 ILI%-.-. _LaTotal Depth <br /> ,.. Screen Length (from) (to) <br /> Well No.:,'1' k. 1 �' Filter Pack: (from} . - (to) <br /> Bentonite (from) (to) <br /> Inspector. 1nAp ,_ _ _ Grout (from) (to) <br /> Drilling rig type <br /> 1 Permit No. Auger O.D. <br /> Completion - Stove pipe/christie box (circle,one) <br /> Drilling Company: � . <br /> Driller: casing ' <br /> height <br /> Consultant + <br /> Geologist <br /> ABOVE-GACtJND CFitSTY-8oX <br /> OQMPtETiON COMPLETION <br /> SPECIAL PERMIT INFO. (around Surfacs <br /> Distance to sewer line grout 6A" , <br /> Domestic well on site- (y/ n ) 1/4 <br /> If yes, location and distance - it. <br /> ,�� tt. ft. <br /> v' m <br /> � w <br /> SAMPLING <br /> socIcrti ILI: <br /> Holding Temperaturevd pads <br /> S — <br /> � <br /> Method ra <br /> Screening Method -- <br /> Tracking Sheet h- (y/ n') <br /> - <br /> SPOILS , P <br /> R.'Storage Method - , t 'MATERIALS/DEVEI.OPMENT <br /> Contamination Noted - (y/ n ) . <br /> Storage Location r' t` Casing type 0.01 � ' b <br /> r Blank . ft. Screen /d ft. <br /> ' SIot size 0.0/ <br /> GROUTING ,—""� Bags cement <br /> ` Buckets bentonite <br /> 4 Depth to water i '` 1 Bags sand/gravel..- <br /> Mix <br /> and/gravel .-Mix Ratios ' Filter Pack type/size I <br /> Installation Method "Surge Block: - ( y/ 11 } <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />