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ysiONITORING WELL INSTALLATION REPO. w <br /> Date: �� �D'�l�T A CONSTRUCTION <br /> Premise Address: ;T5 I;lll, )ISM (AVb Total Depth Z� <br /> '�\ Screen Length (from) a p (to) <br /> Well No.:��W, � � Filter Pack (from) L f (to)= <br /> n Bentonite (from) (to) 3 <br /> Inspector: Grout (from) (to)� Pl <br /> Drilling rig typ <br /> Permit No. Auger O.D. Z <br /> �� Completion - Stove pipe c 'stie bo (circle one) <br /> Drilling Company: n wL <br /> Driller: casing " <br /> height <br /> Consultant ('IRM b�A <br /> Geologist J11V NY/�i�fI ABOVE-GROUND <br /> OUND CHA M43OX <br /> COMPLETION COMPI.En <br /> SPECIAL PERMIT INFO. Ground Sulam <br /> Distance to sewer line grout <br /> Domestic well on site - (Y/ 3 <br /> If yes, location and distance - , <br /> n/W� Win. rt. <br /> — o <br /> _ <br /> _ a <br /> SAMPLING slotted <br /> �un s�c4on <br /> Holding Temperature V <br /> Method - <br /> gravel pack <br /> Screening Method <br /> Tracking Sheet - n ) <br /> 2 D <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y <br /> Storage Location )tJ-5 6 IN 11 Casing type A06 K(— SOW 4A 7i <br /> Blank 4 ft. Screen 15 h. <br /> Slot size C> . 5-2,0., <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water / b Bags san avel <br /> Mix Ratios 140 I 1' ��b Filter ac�type�ize <br /> Installation Method_ Surge Bloc (y/ <br /> Quantity Installed 7, bAM Discussed with geolc st: -�/ n) <br /> Type of method (A <br /> EH 29 29 <br />