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MONITORING WELL INSTALLATION REP-ti-T <br /> Date: 1 I�'Del CONSTRUCTION <br /> Premise Address:L'�y'-� �' � � A, TbTotal Depth h, <br /> _�� Screen Length (from e (to) <br /> Well No.:C� � ��� S44,;iFilter Pack (Ero (to)-7 <br /> Bentonite (fr ) (to) <br /> Inspector. -1 Grout (fr m) (to) <br /> _ Drilling rig type <br /> Permit No. � L Auger OD. I.O. <br /> Completion - ove pipe/chrisae box (circle one) <br /> Drilling Company: r,01 NA �� I <br /> Driller. casing <br /> height <br /> Consultant �-�l� - <br /> F=i7 <br /> Geologist <br /> Y'""" !=TSCN C_-*4P(=uCN <br /> SPECIAL PERMIT INFO. GCO"nd Stxl'" <br /> r <br /> ?r Cut <br /> Distance to sewer line �1�-�" I <br /> Domestic well on site - ( y/ n ) + `t• <br /> If yes, location and distance - t. <br /> O <br /> a <br /> SAMPLING sLonad <br /> aac- _ J <br /> Holding Temp tune y _ <br /> Method U�l <br /> Screening Me od • i�) 7 _ <br /> Tracking Sheet - C(7/ n ) _ <br /> ;f. y — T f <br /> SPOILS <br /> Storage Method �` % /DEVELOPMENT <br /> Contamination Noted - / n ) <br /> Storage Location Casing type <br /> Blank ft- S -een <br /> Slot siz7Cy <br /> GROUTING Bags ce <br /> Bucketsbent <br /> Depth to water <br /> N 7 I > ) Bags s <br /> Mix Ratios CFilter Pe <br /> Installation Method��o d*� Surge Bn )Quandry Installed 3'S Ru Discusslogist: - C y/ n) <br /> Type of method <br /> EH 29 29 <br />