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MONITORING WELL INSTALLATION REPORT <br /> Date: i4b CONSTRUCTION <br /> 1 <br /> PremiseAddress: ��c u„�bvv�- Total Depth_ �Sl <br /> Screen Length (from) �— <br /> Well No.: t1 "-7� f1/� �t�.1 - lu W--2- . Filter Pack (from) <br /> • Bentonite (from) � ` (co) 6�— <br /> Inspector: �-en,v�ew- Grout (from) 60 <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/clu-tstie box (circle one) <br /> Drilling Company:- t,At�-e F <br /> Driller:_ �1c�v. `iV���n.. _ _ n14_' casing <br /> height <br /> Consultant <br /> Geologist_ mac,L-\.V-\ c-\ �XAKAOt_ <br /> A_°G E-GrRCUND <br /> c"1 Ck�STl'30X <br /> OD lrsr'LET{O N C�.Pt�-T1CN <br /> SPECIAL PERMIT INFO. Orwr'd Sulact <br /> Distance to sewer line <br /> Domestic well on site - (.y/'n ) 6 It. <br /> If yes, location and distance - 3 �• <br /> - C <br /> SAMPLING IIorQ-d — C <br /> Holding Temperature <br /> Method — <br /> Screening Method i �� _— <br /> Tracking Sheet - n ) - —_ <br /> S ft, — �S fit. <br /> SPOILS <br /> Storage Method r",^ r)ia/--, 4-i c MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ <br /> Storage Location r,n p i t Casing type Z ' I V C <br /> Blank_ ft. Screen ZC., ft- <br /> Slot size C, L 6) <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water ? Bags sand/gravel <br /> Miz Rados e �E , s ni,N in�. Filter Pack type/size <br /> -ijnstalladon Method ( Surge Block: -0>/n ) <br /> Quantity Installed Discussed vrith'geologisr. - ! yy n ) <br /> Type of method — <br /> EH 29 29. <br />