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MONITORING WELL INSTALLATION REPORT <br /> Date: -3/,i Z4�1 CONSTRUCTION <br /> // i <br /> Premise Address: Total Depth J-? - <br /> Screen Length (from) -rf (to) 3� <br /> Well No.: �� Filter Pack (from) , (to) 3G ' <br /> Bentonite (from) .1^- --(to) <br /> -J/--,1=7C- <br /> Inspector. �ZIt S Grout (from)_ V ' (to)• <br /> Drilling rig type = ' <br /> Permit No. Auger O.D. <br /> Completion - Sto a pipe%lirtsne b9x circle one) <br /> Drilling Compan <br /> �/ 0+7 casing <br /> Drille � <br /> he; <br /> Consultant -F6 -*V <br /> �L�s,°'�c�1 ✓ <br /> Geologist I/ <br /> J180VE-G8CUND �CHSZTI;Y;aACO�Xc7{ON SPECIAL PERMIT INFO. aroundgrout <br /> Distance to sewer line <br /> Domestic well on site - ( y/ n4j <br /> If yes, location and distance - 3 9 3 ft- <br /> v � � <br /> - C <br /> O <br /> SAMPLING C <br /> soc:cn — <br /> Holding Tem e;ature Ll`C <br /> Method <br /> Screening Method <br /> Tracking Sheet - (�/ n) <br /> tL <br /> SPOILS <br /> Storage Method rA ' to G MATERIALS/DEVELOPMENT <br /> Contamination Noted - , /, Casing tYPa q-& <br /> Storage Location <br /> Blank .%Y ft. Screen iv ft. <br /> Slot size <br /> GROUTING Bags cement <br /> f Buckets bentonite <br /> Depth to water LS Bags sand/gravel <br /> Mix Ratios Filter Pack type/size d <br /> Zaal- <br /> Installation Me od Surge Block: - ( y/ ) <br /> Quantity Installed Discussed with geologist: -)C/ n) <br /> //// / / Type of method <br /> EH 29 29 rG� Yl b �`K �y Ozir �_�9�� <br />