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�...ONITORING WELL INSTALIATION REPO,��: ' <br /> Date: 12 lq • q I _ CONSTRUCTION q5 5 L)F?l wa b� <br /> rr-- t� <br /> Premise Address:_, LooV�'Irl i'I 1'� ! Total Depth <br /> M la} Screen Length (from) (to) 4o, <br /> Well No..• YV Filter Pack (from) ILL (to) 631 <br /> Bentonite (from) 63 (to) W <br /> Inspector. - MEM _ Grout (from) (to) b <br /> � ��� I Drilling rig type <br /> prftit Na. - - Auger O.D. I. <br /> pp�� ,, cluistie box Completion - Stove pip circle one) <br /> Drilling Company: k�r� f'IQ7i �l�tZy ... <br /> Driller: 160 Wr( k' Mit casing <br /> IIheight <br /> Consultant, Ci�rP�a <br /> 7/41 <br /> Geologist --� <br /> J COVE-GRCUND C}i tm-BOX <br /> COMPLETION COMPLETION <br /> SPECIAL_PERMIT INFO trourd Surface <br /> Distance to sewer line9f0� <br /> Domestic well on site - (y/ n (v If yes, location and distance - 40 <br /> ft- <br /> �fi. <br /> _ a <br /> q <br /> wc•' rLY <br /> 4 <br /> SAMPLING slot: r i <br /> o } , aQcticn <br /> S <br /> Holding Temperature <br /> Method 15 1 F , y. _ _ s Pack <br /> Screening Method lR MK"'V 1p Qralysv. . = <br /> Tracking Sheet y n ) : <br /> SPOILS <br /> t <br /> Storage Method h V 6MA MATERIALS/UEVEL.OPMENT <br /> Contamination Not d - (y n / h d 2 C <br /> Storage Location,•. Tey f E n OT bi Thi Casing type `�'i <br /> !'r ♦ +? t �- Blank r ft. Screen ZD' -- ft. <br /> SIot size 4 <br /> GROUTING . Bags cement4-ruce— <br /> Buckets bentonite e 6wimik, t G <br /> Depth to hater`; + { x Bags sand/gravel <br /> Mix Ratios LOA I Ad Filter Pack type/size bags <br /> Installation'Method' Vt1 Surge Block::- &/ n ` <br /> Quantity Installed } ' Discussed with geologist: - y/ n) <br /> Type of method_ 1`1 b! <br /> EH 29 29 <br /> P <br />