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r. <br /> MONITORING'WELL INS'T'ALLATION T <br /> Date: 2/ Z q / 4 CONSTRUCTION <br /> Premise Address: 70o ��'e�'"[ r Total Depth t/ 2 <br /> Well No.: /�'� k ( Screen Length (from) (to)?_ <br /> Filter Pack (from) (to) 6 z <br /> ,� /_ Bentonite (from)_ a 2- (to) `f l_ <br /> Inspector: �•�r+c' O�=1„� Grout (from) .l' (to) <br /> Drilling rig type_ E 91 <br /> Permit No. Auger O.D. _ I.D. <br /> Drilling Company..—� 1 g I V,,y, Comple ' ve pi christie box (circle one) <br /> / pp <br /> Driller:- �� F--i Ck- casing <br /> Consultant <br /> Oro M / , CA T'C height <br /> _ C. <br /> Geologist �D/� L M <br /> ABOVE-GR CHRIM-eox <br /> co VWPLETIOW <br /> SPECIAL PERMIT INFO. Ground Strf&= <br /> 7 <br /> Distance to sewer line W°tA <br /> Domestic well on site - ( /n) �-QQr c{Z <br /> fL <br /> If yes, location and distance - <br /> 4SS <br /> SAMPLING ZD IO0O S� slatted a 3 <br /> e 30 O aaetion ". <br /> Holding Temperature, = , <br /> Method packScreening Method n L4 V- ($ <br /> Tracking Sheet - (y/n) <br /> SPOILS <br /> Storage Method i/ �'�"""'S `�" `•"C MATERIALS/DEVELOPMENT <br /> Contamination Noted - /n) <br /> Storage Location O-e%l S t Casing type V <br /> Blank ft. Screen ft. <br /> Slot size 0 <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water S �- Bags sand/gravel 6dXO-S*-- <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Kew Surge Block: ,f/n) <br /> Quantity Installed Discussed widt.*logi t:a(yn) <br /> Type of method r <br /> EH 29 29 <br />