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MONITORING WELL INSTALLATION REPT <br /> ��/3/p( <br /> Date:_ � <br /> �+ � CONSTRUCTION <br /> Premise Address: /0f/11`, �p���yy�f �A, 14 Total Depth 2� <br /> n Well No.: /-�-�Asflyt�( ( 7_3 � ) y la Screen Length (from) Z (to) I6 <br /> J 1 —�--E Filter Pack (from)_ 25- (to) <br /> Inspector: Bentonite (from)__ `1 (to) — <br /> Grout (from) i (to)_s�t<> <br /> Permit No. 50ef/7 Drilling rig type �— <br /> I <br /> Aug e I.D. <br /> Drilling Company:�UoptQtuya ompletion:height <br /> l3/4c" ipe N}tristie box (circle one) <br /> Driller: L <br /> casing <br /> Consultant ,ti <br /> Geologist /J <br /> ABOVE-GROUND <br /> COMPLET CHRt57Y-BOX <br /> SPECIAL PERMIT INFO COMPLETION <br /> Orourd Swiac* <br /> Distance to sewer line <br /> Domestic well on site - Drout <br /> ( Y/n) 1 <br /> If yes, location and distance - 1 n <br /> N.. _ . <br /> 0 <br /> O <br /> SAMPLING <br /> j/^ tlonad = c <br /> Holding TemperatureJy/ry aao''On _ <br /> Method _ va�pack Method = <br /> Tracking Sheet - (y/n ) r <br /> tt. <br /> SPOILS <br /> Storage Method <br /> Contamination Noted ( Y/n ) <br /> - MATERIALS/DEVELOPMENT <br /> Storage Location <br /> Casing type l P✓f' S�-r`.,qO <br /> Blank io ft. Screen � fr, <br /> GROUTING Slot size 0.0 i <br /> Bags cement '2- <br /> Depth <br /> Depth to water_ Lys Buckets bentonite) S <br /> Mix Ratios .r--c k �., T Bags sand/gravel <br /> Installation Method Filter Pack type/size rr <br /> Quantity Installed Surge Block: - (y/ n <br /> Discussed with ge st: - n ) <br /> EH 29 29 Type of method Oy <br />