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MONITORING'WELT.INSTALLATION REPORT <br /> Date: i L 1 1 1 1 CONSTRUCI10N <br /> Premise Address: 1- C7-1 1-�X 1nne" tAA S Total Depth _ <br /> Screen Length (from) Li 5� (to) <br /> Well No.: iM iAJ Filter Pack (from) 3 (to) <br /> Bentonite (from) _ tj 1 (to) (4 <br /> Inspector. Grout (from)" gL -(to), Lf <br /> Drilling rig type <br /> Permit No.. - _Q 2 CI „2,,. ,,. .,,._, Auger O.D. j,zs I.D. <br /> Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company:_ _11 -i V) 1?n�1`, v,n g <br /> Driller: 'It V fR 1- casing <br /> + height <br /> Consultant_—_ -- r' C—�/-Yoo (Y IV <br /> Geologist T©VV\ 'U 1— 171 <br /> - <br /> ABOHE-GFI0UND CHMM-BOX <br /> COIFLUION COMPUETICN <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line <br /> Domestic well on site - (y/ n) <br /> If yes, location and distance - II' <br /> h. <br /> K.. <br /> _ V <br /> v' O <br /> s� a <br /> SAMPLING <br /> 0 <br /> i0t7cn � <br /> Holding Temperature 23a �,cn <br /> MethodA <br /> — <br /> Screening Method = _ <br /> Tracking Sheet - (T/ n ) <br /> n. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) .__. <br /> Storage Location Casing type <br /> Blank 0 5-ft. Screen Cr. <br /> Slot size 02-0 <br /> GROUTING Bags cement .J <br /> Buckets bentonite 1 b-p <br /> Depth to water ^/ 50 t Bags sand/gravei 6- <br /> Mix Ratios ce z Filter Pack type/size <br /> lnstalIation Method Surge Block: - F y n ) <br /> Quantity Installed fv aeAr Discussed with geologist: - n ) <br /> EH 29 29 Type of method <br />