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MONITORING WELL INSTALLATION REPOR <br /> Date: �FI134 CONSTRUCTION <br /> / <br /> Premise Address: .-Tot.v-b�1Depth � , <br /> �` Screen Length (from) �M _(to) <br /> Well No.: �C/ r Filter Pack (from) ` (to) T._ <br /> Bentonite (from) (to) <br /> Inspect _ Grout (from) _(to) <br /> � ;2r <br /> Drilling <br /> Dlmg ng type <br /> Permit No. �'G � Z6 ��ipAuger -� <br /> O.D. �' I.D. <br /> Completion - Stove pipe/ zristie (circle one) <br /> Drilling Company: !/��(it��il ____ <br /> Driller- casing <br /> Consultant ���1/-s' ��I d height: <br /> � <br /> Geologist, � <br /> Alio -GRCUND CNRr,STY-SOX <br /> COfr� TION COMPtrmcN <br /> SPECIAL PERMIT INFO. Ci=nd Uwlwe �"— <br /> Distance to sewer line pralt "7 <br /> Domestic well on site - (y <br /> If yes, location and distance ft. <br /> it. <br /> LO.. <br /> SAMPLING slorad <br /> tacjcn _ <br /> Holding Temperature „� <br /> Method Gv to �' F <br /> Screening Method <br /> Tracking Sheet ( y/ n <br /> SPOILS <br /> Storage Method l/ isciw-c C/T MATERIALS/DEVELOPMENT <br /> Contamination Noted ( y <br /> Storage Location e>,- S"Ae (J¢�CO� Casing type 2- � go AUG <br /> Blank ��-/J' ft. Screen, 2,0. <br /> Slot size . OZ <br /> GROUTING Bags cement <br /> Buckets bentonite % <br /> Depth to water �' .S Ba gravel --s- ,r 6a«s <br /> Mix Ratios Filter Pack type/size 4� <br /> Installation Method bi�..,,� , �a�%�_ Surge Block: - ( y/P <br /> Quantity Installed 7sg Discussed with geologist: - n } <br /> Type of method <br /> EH 29 29 <br />