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S—MONITORING WELL INSTALLATION REPt, l <br /> Date: 7 ' Z'J ' CONSTRUCTION <br /> 9 ' <br /> Premise Address: ��� C„I Total Depth U <br /> Screen Length (from) (to) <�7 <br /> Well No.: �i�� - D/5 - 2 Filter Pack (from) (to) <br /> Bentonite (from) 5 (to) / 2•Z <br /> Inspector: S cQ7�b Eil JAL Grout (from) 2.5 (to) <br /> nDrilling rig type <br /> Permit No. 7 -77 <br /> �J Auger O.D. III <br /> n ' I Completion - Stove pip stie box ircle one) <br /> Consultant �� ' ' � I•-w' E'Y'/l.L. <br /> Geologist 1” 5VAA fJ/'t &Moa - <br /> VVI V. <br /> SPECIAL PERMIT INFO. ABOVE-GROUND <br /> COMPLETION CHRISTY•80X <br /> Distance to sewer line ��d COMPLETION <br /> Ground Surlac� <br /> Domestic well on site - (y/0 <br /> If yes, location and distance - Ott <br /> 62-5 • n. <br /> W 5n. <br /> SAMPLING c <br /> Holding Temperature tion = $ <br /> Method section Screening Method 01//-'( = 9n`'°IPack <br /> Tracking Sheet - ( n) <br /> .r; <br /> n. <br /> SPOILS C) <br /> Storage Method )g4")L72!g' MATERIALS/DEVELOPMENT <br /> Contamination Notes - (}� n ) 000,py'`-- I. f At. <br /> Location C SkT7S Casing type <br /> 0;2Blank ft. Screen__-j2/0 ft. <br /> Slot size 0. CULD <br /> Bags cement <br /> GROUTING Buckets bentonite <br /> Bags sand/gravel <br /> Depth to water_ Z Filter Pack type/size <br /> Mix Ratios Surge Block: - n ) <br /> Installation Method 1 Discussed with geologist: - (y/ n) <br /> Quantity Installed Type of method <br /> 3 e• n/. <br />