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MONITORING WELL INSiALLA,-LION REPORT <br /> CONSTRUCTION <br /> Date: r.s � '' <br /> j <br /> L4 -f <br /> ?remise Address' tal Depth <br /> Soaeen Length (from) (to)��_ <br /> Well No.: �•� r,� Filter Pack (from) �' -_(to) � <br /> Bentonite (from) z (to) ' <br /> Inspector. C Grout (from) <br /> JL- c Auger O.D. ,7 LD., <br /> Permit No. Completion-Stove pipe/c%risrie box (circle one) <br /> Drilling Company: t <br /> r �i casing <br /> Driller: C \ ,t < r ! he;ght , <br /> Consvltani . � <br /> 1 <br /> Geologsz L-L 1 � ' r' - <br /> ,l:k^VSti,ROUND <br /> 0CW—r-T,0N C,^'MP' =,iCN <br /> SPECIAL PEIL1,L'i'INFO. cu-jur+d Svfacs 4 <br /> Distance to sewer line i <br /> Domestic well on site - C y/ n ) <br /> If yes, location and distance- fL <br /> E:. <br /> _ � r <br /> O <br /> SAMPT INC <br /> Holding Temperatureom"a Pack <br /> — <br /> Method •,�� 4 <br /> Screening Method s -- <br /> Tracking Sheet y/n) <br /> ♦ _fL <br /> SPOILS <br /> Storage Method r,,, n, le- MATER ALS/DEVELOPMENT <br /> Contamination Noted - y/ n } type "CIL <br /> Storage Location f Casingn fr <br /> Blank d-k fc Screen <br /> Slot size . 7 <br /> GREG Bags cement '-0 S <br /> Buckets bentonite <br /> Bags sand/gravel <br /> IJepth I4 water � � <br /> r. I C? Filter Pack type/size <br /> Mix Ratios n -r c� .,r Surge Blodc - C Y/ n) <br /> Installation Methods `1 <br /> ' Discussed with geologist: - C y/ n ) <br /> Quantity Installed �L% ,�' Type of method <br /> EH 29 29 <br />