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Y fy <br /> MONITORING WELL INSTALLATION REPORT 2- <br /> Date: 'K 1 3c) [ Q�i CONSTRUCTION <br /> Premise Address: 11-0 1 A-IAnrs y'r Total Depth ] l O l_.. <br /> Screen Length (from)- _jQO ` (to) 1101 <br /> Well No.:D ftAAA2- Filter Pack (from) 99s-(to) 1 !T <br /> Bentonite (from) 5. (to) 5 S <br /> Inspector.. ^o n I _ Grout (frosty) r<7 (to)__ _U":i <br /> Dulling rig type <br /> Permit No. Auger O.D. V`,i " I.D. <br /> Completion-Stove pipe/chxisde box (circle one) <br /> Drilling Company <br /> Driller. Cas Ing <br /> he; <br /> Geologist T . K 0'6'Q t►.. <br /> ABCVE�GRCUND d�llSY-c3CX <br /> �t�':�eT'AN G^MPL='i IC2� <br /> SPECIAL PER-W- T INFO. Cxauad Srrtacs <br /> pistance to sewer line <br /> Domesric well on site - (y/ a) <br /> If yes, location and distance - - fL <br /> • <br /> C <br /> O <br /> SAMPLING Waned <br /> sac..nn _ <br /> Holding Temperature �— <br /> Method_/t.r`rNy� M <br /> Screening Method 21 <br /> Tracking Sheet - C � n ) <br /> l l n :i. = _ 1 JL <br /> SPOILS <br /> Storage Method MATERIAI.S/DEVELOPMENT <br /> Contamination Noted 1 / n) <br /> Storage Location casing tYPe <br /> Blank t0 ft Screen ft <br /> Slot size . 210 <br /> GROT-MNG Bags cement <br /> Buckets bentonite <br /> Depth to water N ` Bags sand/gravel <br /> Mix Ratios Filter Pack type/size It x-Lo <br /> Installation Method Surge Block.- - Qf n) <br /> Quantity Installed 'c� Discussed with logist: - ((@/ a) <br /> Type of method <br /> EH 29 29 <br />