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v .-.We <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: // CONSTRUCTION <br /> 1�d �1�� / ' <br /> Premise Address: Total Depth <br /> ,,nnnn Screen Length (from) 73 (to) /3 <br /> Well No.: Ur[� > Filter Pack (from) (to) <br /> Bentonite (from) Il (to) <br /> Inspector: U��6 Grout (from) 17- <br /> (to) _ <br /> �7 4 Drilling rig type 7A <br /> /i <br /> Permit No. ? q3 Auger O.D. 4i3�f` I.D. <br /> �� CompleaoCM, ip c uis� box circle one) <br /> Drilling Company: BrJ ��� <br /> Driller: casing <br /> he, <br /> ConsulJ. <br /> tanty t�(�� ` <br /> Geologist Ali <br /> ABOVE-GAMNO C-i1SrY-BOX <br /> CONFLEMN cOMPL.ncN <br /> SPECIAL PERMIT INFO. Ground Surfacs <br /> w' Grout <br /> Distance to sever line <br /> Domestic well on site -� n ) ft. <br /> If yes, location and distance - / n, <br /> SAMPLING <br /> soc-icn <br /> Holding Temperature �,,,W Pack <br /> Method San <br /> Screening Method <br /> Tracking Sheet - ( y/ n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y ), 5 �"& D / /G <br /> Storage Location /-,>)A ; Casing type <br /> Blank / � ft. Screen /� ft. <br /> Slot size <br /> GROUTING Bags cement <br /> i Buckets bentonite I/ 4r,z <br /> Depth to water Bags sand/gravel -5 "r <br /> Mix Ratios - Filter Pack type/sl' <br /> Installation Method Surge Block: -6. 11 ) <br /> Quantity Installed i Discussed with geologist: - fgp n ) <br /> Type of mediod I;lm, <br /> EH 29 29 <br />