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i 0 <br /> MONITORING WELL INSTALLATION REPOr.i <br /> Date: 3 // 6 CONSTRUCTION / <br /> Premise Address: —mold&4"rAvy Total Depth v <br /> i Screen Length (from) (to) <br /> (to) <br /> (to) <br /> (to) <br /> Well No.: Filter Pack (from) <br /> Bentonite (from) <br /> Inspector: G"`'0.' Grout (from) <br /> Drilling rig type <br /> Permit No. d/C 7 J Auger O.D. LD. <br /> C on - Stove pipe/christie box (circle one) <br /> Drilling Company: (// �•t'� <br /> Driller: f c^ t/ cas ng <br /> yy�i t <br /> Consultant <br /> Geologist �� G� <br /> A80VE GROUN CHRm-80X <br /> MP <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Sauce <br /> Distance to sewer line Ne V grout <br /> Domestic well on site - (yn Z, ft <br /> If yes, location and distance - <br /> ft. <br /> h. <br /> — a <br /> _= m <br /> F <br /> 0 <br /> C <br /> SAMPLING dotted <br /> aecton <br /> Holding Temperature �U VD L <br /> Method = PsvW Pack <br /> Screening Method <br /> Tracking Sheet - ( y/ n ) <br /> / L e. L <br /> _ LJ n. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y n ,t <br /> Storage Location Casing type vl N <br /> Blank ft. Screen fr. <br /> Slot size 20 <br /> GROUTING Bags cement <br /> Buckets bentonite G <br /> Depth to water �✓ Bags sand/gravel JA <br /> Mix Ratios 't Filter Pack type/size <br /> Installation Method Surge Block: -®. n ) <br /> Quantity Installed Discussed with geologist: - (y n') <br /> Type of method <br /> EH 29 29 p <br />