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! I <br /> MONITORING WELL INSTALLATION REPO .T <br /> Date: CONSTRUCi'TON <br /> Premise Address: eJ 6b L'b Total Depth <br /> 31 Z 9PJ-L Screen Length (from)_ i IS (to) <br /> Well No.: x� ' ��� IN (11jA-1Z Filter Pack (from) Z! S . (to) <br /> Bentonite (from)____(.0_([o) <br /> Inspector. i Grout (from) (to) <br /> r+ Drilling rig type_ - - <br /> 2 cI 2 Z Auger O.D. 1.D. <br /> Permit No. - <br /> ' Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: Casing <br /> height <br /> 40# �QWT <br /> Consultant <br /> Geologist ABOVE-GRCUND <br /> C4_+A35TY_a0X <br /> cOWLLTCN COMPt;'37CN <br /> SPECIAL PERMIT INFO. G=rd 5ufact <br /> Distance to sewer line g(cut <br /> Domestic well on site - (y/ n ) q' ft. <br /> If yes, location and distance - �ft, <br /> w <br /> C <br /> SAMPLING `' o <br /> soc]cn — <br /> Holding Temperature _` _— yzav94 panic <br /> Method — <br /> Screening Method <br /> Tracking Shcet - ( y/ n ) �l `: <br /> SPOILS <br /> Storage Method CLAI_� _ MATERIALS £VELOPMENI' <br /> Contamination Noted - ( y/ n ) V C� <br /> Storage Location Casing type t' <br /> Blank ft: Screen ISft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckc nits <br /> Depth to water r- t -A <br /> Mix Ratios 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 />