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MONITORING WELL INSTALLATION REPORP <br /> Date: I 1�l r1 CONSTRUCTION <br /> A^ 3p1 <br /> Premise Address: ' 1�I /�Z�c�c^ Toral Depth <br /> Screen Length (from) to <br /> c Filter Pack (from) 6 (to) -2,0` <br /> Well No.: Yv�tJ'1 /� <br /> Bentonite (from) `( (to) 4,� <br /> Grout (from) (t0) <br /> Inspector: <br /> Drilling rig type <br /> Permit No. I Cl �� ', Auger O.D. <br /> (7 •�� ` j <br /> Completion- Stove pip sne box (cit a one) <br /> Drilling Company: 4-I45"" )4A',7f <br /> // casing <br /> Driller. '(L l& height <br /> Consultant�� ��0o(eq I^ <br /> r + <br /> Geologist <br /> A80VS-GACUND C4+pISTY-30X <br /> OCfjFL,RION COM — CCN <br /> SPECIAL PERMIT INFO. ���Grout-4 Surlwe -- <br /> grout <br /> Distance to sewer line !tjI <br /> Domestic well on site - (y/ n ) + t. <br /> If yes, location and distance - L <br /> _ o <br /> cc <br /> a <br /> C <br /> o <br /> SAMPLING jaoc cn <br /> Holding Temperature <br /> Method <br /> Screening od _ <br /> Tracking Sheet - ( y/ n) iL _ ♦ tt <br /> SPOILS <br /> Storage Method cn �"l�L' io��� c' <br /> viATERIALS/DEVELOPMENT <br /> Contamination Noted - (Y/ n ) Casing type 2 e V p <br /> Storage Location Blank qe ft Screen �' ft <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite S <br /> Depth to water \ U 3 Bags sand/gravel S•a <br /> Filter Pack type/size <br /> Mix Ratios Surge Block: - Q0 n) <br /> Installation Method Discussed with geologist. - (y/ n) <br /> Quantity Installed Type of method <br /> EH 29 29 <br />