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MONITORING WELL INSTALLATION REPt� <br /> Date: 11✓ CONSTRUCTION <br /> Premise Address: 2 rj�S C C-A / Total Depth 2C7 <br /> 11 ^ Screen Length (from) ?-fp (to) <br /> WellNo.: IV1�IJ� Filter Pack (from) ZS u/ (to)� <br /> Bentonite (from) (to) <br /> Inspector. Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling <br /> Completion - Stove pipe/cltristie box (circle one) <br /> Company. �`�� <br /> Driller: I �t\A.L OL) { � casing <br /> height <br /> Consultant �� V� <br /> Geologist r i(Aa - T <br /> A80VE GRCUND CHMM-BOX <br /> n j l A r! OOWLEfION comnEncN Ground PERMIT INFO. N'�'137"1 +nd S� <br /> grout <br /> Distance to sewer line Domestic well on site - (y/ n ) ftIf yes, location and distance - <br /> ft. <br /> o• <br /> SAMPLING D� L dorm <br /> Holding Temperance = �� <br /> Method <br /> Screening Method <br /> Tracking Sheet - ( y/ n ) <br /> 2S <br /> SPOILS <br /> \trn + l <br /> Storage Method +0 5t1�l(a /C�+ MATERIALS/DEVELOPMENT <br /> Contamination Noted • / ) b'd /' t t <br /> Storage Location vl (Pb�e Casing type -C <br /> Blank !�; ft. Screen a O ft. <br /> Slot size O Z CD <br /> GROUTING Bags cement j! <br /> (( II Buckets bentonite <br /> Depth to water `f , Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - on ) <br /> Quantity Installed Sns� Discussed with geologist: • Y/ ) <br /> Type of method <br /> EH 29 29 P(1) b�tc k & <br /> !—J 35!• P,,-, Ce ltbre i 18 <br /> 10 Z2.0 <br /> 13 j25o0 <br /> ac 7 Z5 co <br /> 25 2a D <br />