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MONITORING WELL INSTALLATION REPORT <br /> Date:_ S"2�/ CONSTRUCTION <br /> Premise Address:_ ?+�f$ /Q/(�tt SP�sr�� �,ei �STrf(.v Total Depth 3 5 <br /> Screen Length (from)' <br /> Well No.: ®1/J4)! 01 A)..7 r- 07y •$ Filter Pack (from) / <br /> Bentonite <br /> Inspector: �( YO/0<" Bentonite <br /> (from) (o)13 <br /> Drilling rig type d�+a <br /> Permit No. S��(v7z28 Auger O.D. I.D. <br /> Drilling Company:Vrc LJ <br /> Completion - Stove pipe/christie box (circle one) <br /> De�[,trn,l <br /> Driller:_ r}-2r9N I9A-G4C casing <br /> ,p. height <br /> Consultant I by4e-4 r. <br /> Geologist HARD! �i 7-r37IFN <br /> ABO VE-GROUND <br /> oowPLETON IS71'-80X <br /> SPECIAL PERMIT INFO. COMPLETION <br /> Ground Surface <br /> Distance to sewer line ' ;rout <br /> Domestic well on site - (y/n) �3ft. <br /> If yes, location and distance - <br /> to ft. <br /> ft. <br /> — m _ <br /> 10 <br /> m <br /> SAMPLING o <br /> s b tted — c <br /> " = � , <br /> Holding Temperature sac�on 54 <br /> — <br /> Method — Gn++S4 Pack <br /> Screening Method = <br /> Tracking Sheet - (y/n) <br /> 3 V <br /> ft. ft. <br /> SPOILS <br /> Storage Method— P11 5 MATERIALS/DEVELOPMENT <br /> Contamination Noted - (yAD - <br /> Storage Location 19fl,5 c T{ Casing type 50H YO PLId <br /> Blank 9 ft. Screen /5' ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite_ / 48) IeVff <br /> Depth to water Bags sand/gravel- (o X loUUas CSN <br /> Mix Ratios Filter Pack type/size //2 <br /> Installation Method _Surge Block:_ <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> EH 29 29 Type of method <br />