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MONITORING WELL INSTALLATION REPORT <br /> Dace:_ 112%1 CONSTRUCTION <br /> Premise Address:__ o Z�Ge,�l_ ,���nn.,�� , Total Depth ) 40 , <br /> 0 <br /> Screen Length (from)_ 1 `'(l7 <br /> Ye11 No.: IM W \ Filter Pack (from) 13 fr ` (co)_ 1 �6 <br /> Bentonite (from) 1 3 3 (Eo)--L;;9 1 <br /> Inspector•. _ V1�,�," dv Grout (from)_ 7 ,CS (to)__ 3 <br /> L1 S�� 2. Q Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company:- <br /> Driller:_ ( casing <br /> height <br /> Consultant I Fm 'V <br /> I II <br /> Geologist /YVVIC--" 4_ -f` <br /> ABG VE-G r�I-CIJN D <br /> CG W LET GN Ck :SIY 34X <br /> C#a.PL-T1CN <br /> SPECIAL PERMIT INFO. Ground Su-fact <br /> Distance to sewer line <br /> Domestic well on site - (y/ <br /> If yes, location and distan - tt• <br /> _ 1`10 <br /> -- w <br /> SAMPLING = C <br /> a <br /> Holding Temperature — �Y <br /> Method — <br /> Screenino Method <br /> Tracking Sheet - (y/ ri =' — <br /> _1$;tt. <br /> SPOILS <br /> Storage Method_ /1 MATERIALS/DEVELOPMENT <br /> Contamination Noted - (Y/ n') <br /> Storage Location_ erv,, 5t Casing type 2- P\— <br /> Blank_ -f ft Screen (O �• <br /> Slot size . p1p <br /> GROLJTING Bags cement <br /> Buckets bentonite <br /> Depth to tvater Bags sand/gravel <br /> Mix Ratios Filter Pack type/size -.z. I7- <br /> --lristallation Method Surge Block: - ( y/ n <br /> Quantity Installed Discussed vi-ith geologist: - ( y/ n ) <br /> Type of mctliod <br /> EH 29 29. <br />