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DVITORING WELL INSTALLATION REPOR' <br /> Date: 3���193 CONSTRUCTIONN br <br /> Premise Address: /0 S d U 5' 14'i' P('I Total Depth / 3 <br /> (�8 �� �lU Ill/�Z/ Screen Length (from) (to) <br /> Well No.: �T�91'(9Z,1B13 Filter Pack (from) (to) <br /> /� Bentonite (from) (to) <br /> Inspector: 7H�/Y1d��Jl' Grout (frp) (to) <br /> Drilling rig type Z <br /> Permit No. Auger O.D. I.D. <br /> n� U Completion - Stove pipe/christie box (circle one) <br /> Consultant /t�c�'4 c< /� a l[ <br /> Geologist AlXIb QuAf•'AZI stkk++P <br /> SPECIAL PERMIT INFO. ABOVE-GROUND <br /> COMPLETION COMPLETION Distance to sewer line COMPLETION <br /> Domestic well on site - (y/ n ) Cirouod Sui°°0 <br /> If yes, location and distance - Otyn <br /> KEW 'v1 - tt. <br /> ft. <br /> tt. <br /> _ m <br /> SAMPLING <br /> M' <br /> Holding Teerature _ slcmd <br /> Method _= <br /> Screeningethod : _ grawipack <br /> Tracking Sheet - y n)n <br /> SPOILS nn^ <br /> Storage Method I Ut/ t /sal MATERIALS/DEVELOPMENT <br /> Contamination Notes - y n ) <br /> Storage Locatio ` Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> Bags cement <br /> GROUTING Buckets bentonite <br /> / Bags sand/gravel <br /> Depth to water o� r Filter Pack type/size <br /> Mix Ratios k102? x Surge Block: - (y/ n ) <br /> Installation Method / Discussed with geologist: - (y/ n ) <br /> Quantity Installed %U4df Type of method <br />