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W <br /> M MONITORING WELL INSTALLATION REPORT <br /> Date : !/ 7– Oa CONSTRUC'T'ION <br /> P ${fir <br /> Premise Address : 3 /r9 s S • ` / Total Depth <br /> Length (from) S O (to) 2'�' <br /> Filter Pack (from) 3� � (to) els <br /> Well No. : ✓� � y Bentonite (from) Q3 (to) a.3 <br /> Inspector: C . vz Grout (from) U � <br /> P Drilling rig type <br /> Auger O.D. <br /> Permit No. Completion - Stove pipe! tristie bo.. (c role one) <br /> Drilling Company: Vd' � <br /> �j casing <br /> Driller. Ier.elos tc height <br /> Consultant rr 'T <br /> t� V&GRCUN.D. <br /> T <br /> Geologist 9; ' , E-GRCUND V-iRZ Y-30X <br /> LFrlONCtrwnd SSPECIAL PERMIT 1NF0. asgrout <br /> Distance to sewer l ne 2-0 30 �NDomestic well on site - ( y / �) 35 S�— fto <br /> If yes , location and distance - 0 _ <br /> SAMPLING e ✓o S L �uah � t� / S ' do od <br /> secicn — <br /> Holding Temperature gravDl Pact <br /> Method <br /> Screening Method <br /> Tracking Shcet - ( P/ n ) <br /> �hC U.B-C w 2�� Ito <br /> SPOILS <br /> Storage Method p vu ✓ MATERIALS/DEVELOPMENT <br /> Contamination Noted - ((V/ n ) <br /> Casing type N [ 2" <br /> Storage Location M AW — Blank Wig• Screen h• <br /> Slot size O J <br /> GROUTING Bags cement / O ? <br /> Buckets bentonite [ <br /> Depth to water ti �� Bags sand/gravel d a E n NohJdh "3 <br /> Mix Ratios rtEa.? Filter Pack type/size <br /> Installation Method % uMQ / Surge Block: n <br /> - ( �} ) <br /> Quantity Installed Discussed with geologist: - n ) <br /> Type of method & AjB �J <br /> EH 29 29 <br /> Gtr-a-..L //�� �. Cvo-2'✓., U S .T / � .�l.J � f..,J .�`��-C_ <br />