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*MONITORING WELL INSTALLATION REPOn` <br /> Date: Z00:7- CONSTRUCTION <br /> Premise Address: ���� /1>Nt! 9� Total Depth d <br /> Screen Length (from) D (to) 75 <br /> Well No.: Filter Pack (from)—(to) 3 <br /> J / Bentonite (from)�(to)�_ <br /> Inspector: �r c-fF '-'�� Grout (from) (to) t L <br /> O �DS Drilling rig type Ae-C1/79 <br /> Permit No. 7 / Auger O.D. I.D. 9 <br /> Drilling Comp <br /> Completion - Stove pipe/christie box (circle one) <br /> /any: � V f W #00WWPMLET10N <br /> Driller: KR�K - U.u�.� Y ca 'ng <br /> heig tConsultant Geologist CHRSrY4= <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Gond Surlyy <br /> Distance to sewer line Nj.4 grout <br /> Domestic well on site - (y/ n )- 1 L ft <br /> If yes, location and distance - <br /> = m <br /> — o <br /> = m <br /> — c <br /> SAMPLING dotted - <br /> n <br /> sectio ' _ $ <br /> Holding Temperature ✓rt.-Q IA4- <br /> Method <br /> Screening Method _— <br /> Tracking Sheet - (y/n ) — <br /> ft. ft. <br /> SPOILS �� <br /> Storage Method ��/Y��'-44 f �aw� MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y n <br /> Storage Location Casing type t gk fo /VC <br /> Blank ft. Screen / ft. <br /> Slot size ' 02.0 <br /> GROUTING Bags cement <br /> ' p�t Buckets bentonite 1 r lKi o <br /> Depth to water fit/ Bags sand/gravel w <br /> Mix Ratios /00 C /Zljecq d tc Filter Pack type/size <br /> Installation Metho �istyyeei( 14's,4 Surge Block: - (y� <br /> Quantity Installed_ Z�Ga�a Discussed with geologist: - (y)0 <br /> Type of method <br /> EH 29 29 <br /> O-d 7 16 <br />