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MONITORING WELL INSTALLATION REPORT <br /> els L.J.a� <br /> Date: I CONSTRUCTION <br /> Premise Address: C� z Total Depth //.7 <br /> / i Screen Length (from) /,0 (to) iiI <br /> Well No.: ✓Lln TS M' 1�2D '�" Filter Pack (from) J I / (to)j (X'A <br /> Bentonite (from) 16)1h (to) t 0•- <br /> Inspecton Grout (from) pl V4 (to) I Qom_ <br /> Drilling rig type (Uu� q eTGRN �l <br /> Permit No. Auger O.D. I I–` I.D. <br /> Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company. <br /> casing <br /> Driller: T height: / <br /> Consultant <br /> Geologist S `� ApAVE�3RCUND OhR SfY 30X <br /> CONVLEDON comm nGN' <br /> SPECIAL PERMIT INFO.Su1x� + <br /> —CWT <br /> prem <br /> Distance to sewer line <br /> Domestic well on site - ( y/ n) ft. <br /> If yes, location and distance - D n, ft. <br /> O <br /> _ O <br /> iOnAj <br /> SAMPLING isocicn � <br /> Holding Temperature NIS <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n) <br /> ID g. <br /> � 1/7 <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) Casing type :Y" N✓ <br /> Storage Location Blank 11�- fr. Screen <br /> Slot size 6 07 <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water ' Bags sand/gravel <br /> Mix Ratios Filter Pack type <br /> ,installation Method Surge Block: - O) /d� <br /> Quantity Installed Discussed vrith gist: - (6/ n ) <br /> Type of mcdtod <br /> EH 2924 <br />