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MONITORING WELL INSTALLATION REPORT <br /> Date: 1 (10 ,lO k, CONSTRUCTION <br /> Premise Address: 61 3 I Qaa_ Total Depth <br /> \vJ Screen Length (from) (to) <br /> Well No: Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector. 1Zk/NA�C ft — Grout (from) (to) <br /> '_Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/cluLstie box (circle one) <br /> Drilling Company: (� <br /> Driller: casing <br /> he-ight <br /> Consultant, CfAAJniL. <br /> Geologist Q,n.._ V20.N1z-n1 - T <br /> AWVE-GRCUND C}-nSfY30X <br /> OOWL ETiON =CCN <br /> SPECIAL PERMIT INFO. Suiact <br /> Distance to sewer line <br /> Domestic well on site - (y <br /> If yes, location and dist e - ft. <br /> }}•�ft. <br /> y. o <br /> M <br /> I! O <br /> SAMPLING tlorud <br /> I 'cn - — <br /> Holding Temperature <br /> Method '= <br /> Screening Method <br /> Tracking Sheet - (y/ n) ?. <br /> 47•1� <br /> SPOILS <br /> Storage Methodrrn Imo, cr�41�_ MATERIALS/DEVELOPMENT <br /> Contamination Noted - (p/ n) <br /> Storage Location �,,s�� Casing type y `QV G Gv+w vim( I ft <br /> Blank X1-S• fc. Screen I—.rZ <br /> Slot size_ . 0 1.0 — <br /> GROLMNG Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel g <br /> MIX Rados_ Filter Pack type/size af I z <br /> 4pstalladon Method Surge Block: - (y/n ) <br /> Quantity installed N Discussed vrith geologist: - ( y/(n) <br /> Type of method <br /> EH 29 29. . <br />