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OONITORING WELL INSTALLATION REPO <br /> Date: CONSTRUCTION <br /> Premise Address: p� G �M �"�— Total Depth 1-5' <br /> b <br /> C/L Screen Length (from) (to) <br /> Well No.: �W-I'm 6,t) 36A Filter Pack (from) (to) <br /> —' Bentonite (from) (to) <br /> Inspector: Grout (from)—(to)—N „ <br /> Drilling rig e <br /> Permit No. Auger O.D. <br /> Completion - Sto pipe/christie box (cir le one) <br /> Drilling Company: 6^�`��i L f'I 0a3ALX- 5V-10 34ALt-I <br /> �/� �d casing <br /> Driller: INT <br /> height <br /> Consultanty <br /> Geologist AVE-GROUND <br /> COf.�LETION CF4iSTETIOX <br /> (A) 35 tt-TioN <br /> SPECIAL PERMIT INFO. - ('� A'Vj � Ground Sumacs C� QtiP <br /> crs 0) grout <br /> Distance to sewer line <br /> Domestic well on site - (y/ n ) ft. <br /> If yes, location and distance - ft. <br /> tt. <br /> — a <br /> = m <br /> _ d <br /> = c <br /> SAMPLING P1Aslodad <br /> scion <br /> Holding Temperature Gni Pack <br /> Method = <br /> Screening Method <br /> Tracking Sheet - ( y/ n0 AKA) <br /> SPOILS 3 6WA <br /> Storage Method ` M MATERIALS/DEVEL NNT <br /> Contamination Noted C- (y/ n ) J/ d If 11 <br /> .5 <br /> Storage Location .5WA4 I t ro 7 ��y^ Casing type I b <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water /�(5 Bags sand/gravel <br /> Mix Ratios O l Filter Pack type/size <br /> Installation Method ° ` Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />