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NITORING WELL INSTALLATION REPO <br /> s� u: <br /> Date: ( � ; CONSTRUCTION <br /> 140 <br /> Premise Address: LOA ITotal Depth <br /> ' a� M - - Screen Length (from) (to) <br /> WeII No . <br /> Filter Pack (from) (to) <br /> --— -. Bentonite (from) (to) <br /> Inspector: iM Grout (from) {td) <br /> xx �.�{p Drilling rig type <br /> Permit No. {' J � -�1 1 Auger O.D. I <br /> S 2V'r Completion - Stove pipe/ ulsiie bo (circle one) <br /> ny: <br /> Drilling Compa , (�' <br /> Driller: JV'IVl rr1.)eko� T caging <br /> d �.� w�. _ height <br /> Consultant .d <br /> 14 <br /> Geologisi(VRn M 5 <br /> LDS V� JtBQVE-GRCCMDWT <br /> CHAZTY43OX <br /> CONFLE CN x ,,• <br /> COMPLEnCN <br /> SPECIAL PERMIT INFO. - Ground Sudo4t <br /> Distance to sewer line -- - `grout <br /> Domestic well on site - (y <br /> ' (t• <br /> If yes, location.and distance - I <br /> Mw Mw �n. _ <br /> SAMPLING �� �. j/ dot'.t.9 <br /> Holding Temperature <br /> Method 1 <br /> Screening Method Flo <br /> Tracking Shcet V n ) <br /> SPOILS <br /> Storage Method- MATERTALS/DEVELOPMENT <br /> Contamination Noted " <br /> Storage Location 'enJ Casing type <br /> V � Blank 5 D ft. Screen <br /> f" <br /> `� D ft. <br /> r'Q. - Slot size D <br /> GROUTING Bags cement <br /> Buckets bentonite a <br /> Depth to water Bags sand/graveIk16 41 Z/f <br /> Mix Ratios Filter Pack type/size <br /> Installation Method trg_pi W le _ Surge Block: - (y n <br /> Quantity installed - _„ Discussed with geologist: - n) <br /> sType of method a l <br /> EH 29 29 �D AU <br /> �•iJ&d` <br /> F <br /> il: f <br /> �} it <br />