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MONITORING WELL INSTALLATION REPT <br /> Date: -5 '� "4 I CONSTRUCTION <br /> r <br /> Premise Address: d2-qi W . LULICC U Total Depth_ .� <br /> Screen Length (from) (to) <br /> Well No.: J 2 F ck (from) (to) <br /> Bentonite (from) <br /> Inspector: �Cl�l tJ n�L%'�L. - Grout ) (to) <br /> nr Drilling rig type <br /> Permit No. 7 ��� _- Auger O.D. I. <br /> Couple on- Stove pipe/thristie box (sir one) <br /> Consultant '�'�C�?�(L <br /> Geologist nr_)'N <br /> . T <br /> SPECIAL PERMIT INFO. .f VE-GRCUN0 <br /> LE7fON CHRiSTY-80X <br /> COMPLETION <br /> Distance to sewer line Grose ace <br /> Domestic well on site - (y/D) <br /> If yes, location and distance - grout <br /> SAMPLING , — c <br /> O <br /> Holding Temperature 4-° ° <br /> J <br /> w+ <br /> Methodir'_ (��(Lu�, t � 1 C - soon ' _ <br /> ScreeningMethod „: __ Val pack <br /> Tracking Sheet - ({ n) _ <br /> SPOILS <br /> Storage Method e dy' '(__ MATERIALS/DEVELOPMENT <br /> Contamination Notes - (y/ n ) <br /> Storage Location Ca ' g type <br /> Blank ft creen ft. <br /> Slot size <br /> Bags semen <br /> GROUTING Buckets benton• e <br /> Bags sand/grav <br /> Depth to water Filter Pack a/size <br /> Mix Ratios lD Surge Blo : - (y/ n ) <br /> Installation Method Discuss with geologist: - / n ) <br /> Quantity Installed Type f method <br />