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ILIENITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address: �2 ► �CGir Total Depth <br /> +� <br /> Green Length {from) b (CO) <br /> Well No.: jr - ^- 5lilter Pack (from) SO (to) <br /> Bentonite (from} --S _ (to) <br /> Inspector: s, Grout (&om)_ ��/ - (to) .� <br /> � <br /> 7� w <br /> Drilling <br /> O.De� `fin//' -1 I.D.:p <br /> Permit No.• � !mac _-- 'Auger <br /> „ Completion - Stove pipe/(circle one) <br /> Drilling Company: <br /> Driller: �l•GtiY�� _ casing� he{ght .. <br /> Consultant, <br /> Geologist -- <br /> AWVE-GRCUND Cwtm-80X <br /> W MPLtTION <br /> COMPLETION <br /> SPECIAL PERMIT INFO. / x Ground Surfaet ..�— •�- --••�•• <br /> Distance to sewer line - prert, <br /> Domestic well on site - (y <br /> If yes, location and distance - r ts- <br /> GG�ft. <br /> m. <br /> a•. a <br /> iA <br /> SAMPLING ilar.� <br /> tccycn <br /> Holding Temperature <br /> Pack <br /> Method �av� <br /> Screening Method <br /> Tracking Sheet ( y/ n ) <br /> .r.ft. ?!- <br /> SPOILS <br /> Storage Method 56_ -0 MATERIALS EVELOPMENT <br /> Contamination Noted - ( 1 <br /> Storage Location Casing type <br /> Blank ft. Screen Zp ft. <br /> Slot size -_ •OZ <br /> GROLMNG Bags cement <br /> Buckets bentonite_ _ <br /> Depth to water Z Ag Bags sand/gravel <br /> Mix Ratios Filter Pack type/size .P <br /> Installation Method Surge Block: - fGp ti ) <br /> Quantity Installed__ - 7�"A•,G,.. Discussed with geologist: - n ) <br /> - y <br /> Type of method <br /> EH 29 29gres1_fix;l /a <br /> . i <br />