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MONITORING WELL INSTALLATION REPORT <br /> Date: O ���.' 05- CONSTRUCTION Gas r 4j "/iFs i4H-411"Opo' <br /> Premise Address: Total Depth 3S <br /> Screen Length (from) 3s ' _(to) <br /> Well No.: /VI w ! Filter Pack (from) 3S (to) `f <br /> �n Bentonite (from) /�' (to) <br /> Inspector. 1 Ck 0`�1 r` n Grout (from) <br /> Drilling rig type 13 -S3 <br /> Permit No. 434 2� Auger O.D. fT i n I.D. <br /> Completion - Stove pipe/cluistiebox^(circle one) <br /> DrillingCompany: <br /> I <br /> DrillerS: V �D casing <br /> 64�ssstgrls- S'�» �Ko <br /> height <br /> Consultant la rn r'a . <br /> Geologist 0 "� vi Fe n 1_�_ ABOVE-GROUNDX , <br /> COh�'L�TION <br /> SPECIAL PERMIT INFO. �! 7 ' �� s �P m Cnd Sui'c' <br /> V7' " l• jPp'1'1 pra t <br /> Distance to sewer line ` <br /> Domestic well on site - y n) <br /> If yes, location land distance - / / h• <br /> 'The dip w.eS'f c, /�(��- 1�! /G T Ge.f" s•f2. <br /> SAMPLING _ no 5e 1 �f Gv�"c itorai <br /> cn M <br /> --�TYsxi = <br /> t <br /> Holding Temperature_ <br /> Method ,, k�27 01 } <br /> Screenin;MethodD <br /> Tracking Sheet jn) 3S- <br /> SPOILS S-SPOILS <br /> of���e MATERIALS/DEVELOPMENT <br /> Storage Method SS����� /'y_rn if �i -// <br /> Contamination Noted - ( / Casing type a,k <br /> Storage Location Blank r fr. Screen -1-0 ft <br /> Slot size <br /> Bags cement <br /> GROLTIMNG Buckets bentonite ►- o r <br /> Bags sand/gravcl -/D <br /> Depth to water 'b <br /> Miz Ratios S - �� ����� � Filter Pack type/size <br /> installation Method a9 Surge Block: - Uy/n ) <br /> Quantity Installed Discussed vrith geologist: -�/ n) C <br /> Type of rnctliod S +' d <br /> EH 29 29. - <br /> . <br /> �b `1� I-Wf Q`/'o4"'e"O� 4 J <br /> %` <br /> 0 of . <br />