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TM MONITORING WELL INSTALLATION REPORT <br /> Date: "Z v CONSTRUCTION - <br /> t <br /> Premise Address: Total Depth <br /> Screen Length (from? 5 __(to] 2-0 <br /> - Well No.: M C�.l'3 _ Filter Pack (from)_ �`' (to}�_ <br /> Bentonite (from) (to)_ 1i' <br /> Inspector.U� _Coy,-- Grout (from) O (to) 3.S <br /> Drilling ng type <br /> Permit No. n -4- _ Auger O.D. I.D. <br /> Completion-Stove pipe/christie box circle one) <br /> Drilling Company, <br /> TCasing <br /> Driller.,_ - T height_ w. _. <br /> Consultant Y1 u _ • T x <br /> -GeologistLt�\A,.t: } n -e=.� rc. ABCVE,GiqCLWD <br /> �lrP!�T'AtV q�.�.�Fyi1�S� Y-SCX <br /> r SPECIAL PEPUN= INFO. Grxlt�d Se�rtaea <br /> gr= <br /> Distance to sewer line <br /> Domestic well on site - (y/ n ) ___ �. ft. <br /> If yes, location and distance - <br /> - O <br /> xWuspd <br /> L G <br /> S--HUNG <br /> Holding Temperature <br /> ... .Method_ _ a •.,� Y . <br /> Screening Method <br /> Tracking Sheet <br /> SPOILS , <br /> Storage Method <br /> Contamination Noted - (y/0n ) <br /> Storage Locadon Casing tYPe <br /> Blank fc Screen <br /> .Slot size o <br /> GROUTING Bags cement <br /> ` Buckets bentonite <br /> - Depth to water .�J Bags sand/gravel '� S <br /> Mix Ratios U -�Filter Pack type/size � 4� <br /> -� InstaUarion Meth Surge Block= - / n) <br /> Quantity Installed Discussed with eologist: - (y/ n) <br /> Type of method <br /> EH 29 29 a <br />