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MONITORING.VVELL INSTALLATION REPORT oz� <br /> 2 -7 � �8 _ ,/gry/'ryc ems• S•lc /p:S'S-lrsy <br /> 07 CDNs RUCTION <br /> Date: L, d /09 <br /> 7 S7?f /4� f Total Depth (to)Loq <br /> Premise Address: /� Sween Length (from)_Z (to)!o 9 _ <br /> /� Filter Pack (from)—�—(to) SL <br /> Well No.: Bentonite (from) $ <br /> Grout (from) <br /> Inspector. Drilling ng type — <br /> Auger O.D. /�— <br /> permit No Completion - Stove pipe/cluune box (circle one) <br /> Drilling Company. �A�6id <br /> �c--- t I i <br /> hei5ht <br /> Driller: <br /> Consultant <br /> `i� �/dor ✓ A?lOVE-GRCUND ck-nSM-30X <br /> Geologist COWF�EfiON CpF,t?t='-ncN <br /> ��C�ixrnd Suiac't <br /> SPECIAL pERM[T INFO. peat <br /> Distance to sewer line tt <br /> Domestic well on site - C Y/ n) <br /> If yes, location and distance - tt. <br /> yO <br /> - M <br /> C <br /> - O <br /> {iOrA� 'Q <br /> SS G iPC1Cn <br /> Holding Temperature <br /> Method ` — <br /> Screening Method ': =_ f< <br /> Tracking Sheet - (y/ n) _- -n• -- — �7 E <br /> `s«nA`/ ok <br /> SPOILS <br /> .�.TERIALS/DEVEI.OPMENT <br /> Storage Method <br /> Contamination Noted - (Y/ n) Cuing type <br /> Blank--{t. Saeen•_--- � <br /> Storage Location Slot size <br /> Bags cement <br /> GROLMNG Buckets bentonite <br /> Bags sand/gravcl <br /> Depth to water Sung Pack type/size <br /> MIX Ratios Surge Block: - (Y/1") <br /> Discussed with geologist: - Cy/ n) <br /> if Quantity <br /> i Method Type of method <br /> Quantity installed <br /> EH 29 29 <br />