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MONITORING WELL INSTALLATION RFPORT <br /> Date: TI <br /> __=_(�� (o 16 S' rr CONSTRUCON <br /> Premise Address: W Total Depth_ +� Z•S <br /> Screen Length (from) t (to)_ 3 Z <br /> Well No.: IV\W-- Filter Pack (from) 1 (to) L•✓' <br /> Bentonite (from) I ?— (to) /5- <br /> Inspector. ,rry Grout (from) (to) �7 <br /> Drilling rig type <br /> Permit No. N`�; �`I Auger O.D. I.D. <br /> / A Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company: 1.)rg� wa,.`/1 <br /> Driller: le.oikri') � casing <br /> he; <br /> Consultant, � } <br /> Geologist scoA � dJrl�atnii'I � <br /> APOVE-GRCUND eF^A:STY-30X <br /> CX7h4'LETION GCK,4PtZnCN <br /> SPECIAL PERMIT INFO. ------G=nd Sutscr <br /> Distance to sewer line <br /> Domestic well on site - / n) 1 Z It <br /> If yes, location an stance - <br /> ft. <br /> tt. <br /> — o <br /> IY = O <br /> SAMPLING ilonad M <br /> 4 c 1 __ <br /> Holding Temperature a j% �l <br /> Method MA icy <br /> Screening Method 06 <br /> Tracking Shcet - (}� n ) r; <br /> s a rt, — a•s tt. <br /> SPOILS <br /> Storage Method ro aL( MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) <br /> Storage Location Casing type Z PVc� - <br /> mank r fr. Screen 14 i fT- <br /> Slot size OZ0 <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mist Ratios Filter Pack type/sizel=��� <br /> installation Method Surge Block: - (y/ n <br /> Quantity Installed Discussed with geologist: - (y/ i <br /> Type of method <br /> EH 29 29 <br /> • •` <br />