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E (7JNITORING WELL INSTALLATION REPO,_. YI <br /> Date: 2 "I� �1 CONSTRUCTION <br /> Premise Address: '��• 477u-5-Hazz Total Depth 7U <br /> Screen Length (from) -7/7 (to) <br /> Well No.: (� "r'J Filter Pack (from) ,•'_(to) Z <br /> Bentonite (from) (to) <br /> Inspector: '5. ';SCb47JiS7L Grout (from)_ (t -�' <br /> Drilling rig type <br /> Permit No. - X15 j Auger O.D. hD. <br /> Completion - Stove pip uistie box (circle o e) <br /> Drilling Company: _- <br /> Driller• caaLrg*•-- <br /> TheLght, <br /> Consultant _EWT <br /> Geologist <br /> AE&F-4RCN'D Ci FUM-SOX <br /> COMPLEr10�! COMI'LEnoN <br /> SPECIAL PERMIT INFO, Cttnurd Sutfacs <br /> Distance to sewer line 1 grail <br /> Domestic well on site - {y/ n ) �_.tt• , <br /> If yes, Iocation and distance - n• <br /> R. <br /> Cr <br /> SAMPLING w slored _ 4� <br /> ,do •i%• M <br /> Holding Temperature G N 9MVW Pack <br /> Method �GcS <br /> Screening Method NonFu�' — <br /> Tracking Sheet - yn) <br /> p{� .:i• <br /> SPOILS w, <br /> Storage Method 6i'j .A*-3n)nL_ MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y lzff� <br /> Storage Location ON- Q fL cs Casing type 2 `'C bel 4U /04L <br /> Blank ft. Screen ft. <br /> Slot size O. O <br /> GROUMNG Bags cement <br /> Buckets bentonite 1 cam' <br /> Depth to water Bags sand/gravel 7 r04el <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - W n ) <br /> Quantity Installed Discussed with geologist: - ' n ) <br /> _Type-of method, <br /> EH 29 29 <br />