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• r" 1f <br /> MONITORING WELL INSTAII.ATION REP_eT <br /> I�\ " V I <br /> CONSTRUCTION _ <br /> ?remise Address: <br /> Total Depth <br /> n I Screen Length (from) '� (to) �}5 <br /> Well No.: / "��/'j l C M �. W l Filter Pack (from) rO (to) 4 -3 <br /> Bentonite (from) (to)_ 40 <br /> Inspector Grout (from) (to) <br /> // <br /> Drilling rig type <br /> Permit No. Auger O.D. I.O. <br /> Completion - Stove pipe/cnristie box Ccirde one) <br /> Drilling Company 5` 47 <br /> C casing <br /> Driller. �Y� � height T <br /> I <br /> Consultant �7���Z� --�— <br /> U, rMU <br /> Geologist !V I J�Cf4�'i , S� AgDyr,GRa;ND <br /> i I 1 C�MP�.=i,CN <br /> SPECIAL PERMIT INFO. ZJ Gf°"`� � <br /> fJ� <br /> IN <br /> ' <br /> �toc.K <br /> Distance to sewer line <br /> Domestic well on site - ( y/ n ) <br /> If yes, location and distance - 73 <br /> v O <br /> SAMPLING :lcand <br /> Holding Temperature — " <br /> Method <br /> Screening Method Ike <br /> Tracking Sheet - C Y/ n ) <br /> :i. ♦ = T tt. <br /> SPOILS lW <br /> MATERLM S/DEVELOPMENT v <br /> Storage Method S`bP �. <br /> Contamination Noted - (y/ n ) Casing type l� <br /> Storage Location Blank b een ft <br /> M3 Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/siz <br /> Installation Method Surge Block - C y n <br /> Quantity Installed Discussed with geo gist - C Y/ a) <br /> Type of method <br /> EH 29 29 <br />