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`r MONITORING WELL-INSTALLATION ItEPOR <br /> t <br /> .. #.y <br /> Date: - ft�.. .�� r CONSTRUCTION <br /> Premise Address: �f - L ���_{,�y` Total Depth <br /> Screen Length (from) Z (to) <br /> Well No. 1%`.' _. ...Filtez.Pack, (from) j -(to) <br /> Bentonite (from) to) E <br /> Inspector. _ �- - -:�i.•r . Grout ...(from) <br /> Drilling rig type <br /> Permit No. - �� w » : -.. Auger O.D. .D. <br /> Completion St ve ipe c iristie box (circle one) <br /> Drilling Company:_ <br /> Driller: Z.Cl -�y� casing .. <br /> Y height r�� <br /> Consultant - a V rg <br /> Geologist ��. _. , _�» -.,. <br /> JW ASQVE�RCUND CHRMTY-WX <br /> COMPLETCN COM>'LETlO <br /> SPECIAL PERMIT INFO. nd SU40 <br /> Distance to server line xw �((` grcut <br /> .- b r <br /> Domestic well on site- (y/ n ) � � ��-�-=---tt. <br /> If yes, location and distance <br /> SAMPLING slored yr <br /> Holding Temperature _ r <br /> �iY9I pack, <br /> Method <br /> Screening Me d" . <br /> Tracki�ngeet - (Y/ n) <br /> x <br /> SPOILS <br /> '2 fD4 <br /> Storage Method UrVY015, !MATER.IALS/Dl~VE[.O_P_ME_ <br /> Contamination Noted - y n ) <br /> Storage Location 4_Casing e ` z 4 <br /> Blank - ft. -Screen- <br /> GROUTING Bass{cement - <br /> . -Euckets bentonite ;_ . <br /> Depth to water �. Bags sand/gravel <br /> Mix Ratios - -Filter..Pack a ize <br /> tYP <br /> t1 " <br /> Installation Method ��°� <br /> Surge Bloc t7 <br /> {'y n } <br /> Quantity Installed - - Discussed wit ogist: -.(y n ) • t'. <br /> Type of method <br /> EH 29 29 _ _ . ... . . _ • - • .•�� _ t _ �n _ <br /> - ._ .. .-. .+ � ...�� � .L..+i..,...... .�- �.nr,�.6�w.. ry.e.,n xr:► .,..w-,. . .w, .,aj�.-: . .. .. -,.e-yes a <br /> -- <br />