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ONITORING WELL INSTALLATION REPO <br /> Date: ✓ Z"y CONSTRUCTION <br /> Premise Address: .4707 A&,LA/ - AV,'- Total Depth <' <br /> Screen L (to) 'Z <br /> Length (from) 3 <br /> Well No.: `aJ - Filter Pack (from) 4 z5 (to)—Z <br /> Bentonite (from)�(to)T <br /> oc_ <br /> Inspector: `� SCtfNcIbGrout (from) (to) <br /> _ Drilling rig type <br /> Permit No. �� -U�yJ Auger O.D. %u .: I.D. S'.z <br /> Completion - Stove pipe tristie box `(circle one) <br /> Drilling Company: � � <br /> lJ'r — casing <br /> Driller: <br /> n height <br /> Consultant Kc�N'A —qV <br /> Geologist leki4 'r k)_ LL ABCVE•GRCUND <br /> COACC <br /> �LEiION CNRISMPunL6TIwCN <br /> SPECIAL PERMIT INFO. G=rd SuAx� +��� <br /> proof <br /> Distance to sewer line �I <br /> Domestic well on site - (y/ n ) ft. <br /> If yes, location and distance - ft. <br /> ft. <br /> c <br /> SAMPLING = `~ <br /> dorm — <br /> aoricn — <br /> Holding Temperature 40Q Prot Fade <br /> Method 1 *3 7 W <br /> Screening Method (-"V' pn�) — <br /> Tracking Sheet - / n ) <br /> SPOILS <br /> Storage Method F3+n) MATERIALS/DEVELOPMENT <br /> Contamination Noted • n ) <br /> Storage Location ) u i tr Casing type 4 a2+-I 40 F <br /> Blank ft. Screen h• <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size i-AJ;Z <br /> Installation Method Surge Block: - ( y <br /> Quantity Installed i,.0-� �1 Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />