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MONITORING WELL INSTALLATION REPORT <br /> lh�D3 CONSTRUCTION <br /> Date: <br /> Premise Address: TotalAepOScreen Length (from) l,a I , ( (to) 10 <br /> /� { C� Filter Pack (,from) 11�_.(to) 11 � <br /> Well No.: Bentonite ($otp) Ste— ..—(to)-7 Y t— <br /> Grout Chot3y)_�` <br /> Inspector. ` "" <br /> _Drilling rig typg <br /> Auger O.D. I.D. <br /> Permit No. completion - Stovf,;4 a/christie box (fie one) <br /> Drilling Company: vj <br /> eflit <br /> # <br /> hj <br /> Driller: � he ght <br /> Consultant <br /> 0 —av <br /> Geologis[ Jw AWVE-GSCUND cHRzT7.80X <br /> j oowPLETCN cowpt--moN <br /> ,—o tarot r d Stztact <br /> SPECIAL PERMIT INFO. <br /> prat <br /> Distance to sewer line <br /> Domestic well on site - (y/ n) <br /> If yes, location and distance <br /> = m <br /> c <br /> ilOnO� <br /> SAMPLING to<*n <br /> oval Fxk <br /> Holding Temperature <br /> Method — <br /> Screening Method <br /> Tracking Sheet - (y/ n ) _ ft. <br /> SPOILS <br /> MATERIALS/DEVELOPMENT <br /> Storage Method �w <br /> Contamination Noted - (y/ n ) Casing type h <br /> Storage Location Blank j I fr. Screen— — <br /> Slot size 61�0 <br /> Bags cement <br /> GROUTING Buckets bentonite <br /> Bags sand/gravcl I L <br /> Depth to water Filter Pack type,//s;iz,�ed I v <br /> Mix Ratios Surge Block: - Yl tl ) <br /> Installation Method Discussed with geologist: - q�/ n) <br /> Quantity Installed Type of method <br /> EH 29 29 <br />