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f ru <br /> MONITORING WELL INSTALLATION REP-e-T <br /> Date: Zl b� CONSTRLK—noN (� <br /> Premise Address: L AA � / �� '� Total Depth 7 <br /> Screen Length (from) Cto) <br /> Well No.: Filter Pack (from) .i� (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Aug LD. <br /> mpletion - St pipe/cisristie box (circle one) <br /> d� <br /> casing <br /> Driller. ' eight <br /> Consultant <br /> Geologist ' ASCVE-GROUND <br /> CHRMMYDOAALIiCQN <br /> Suf <br /> SPECIAL PERMIT INFO. `� a= <br /> n� <br /> Distance to sewer line L d <br /> Domestic well on site - ( y/ n ) _--"- <br />` If yes, location and distance - S tL <br /> -tL <br /> -~ � 3 <br /> k <br /> SAMPLING <br /> wc,.cn <br /> Holding TemDerature = 71VII Pack <br /> Method <br /> Screening Method <br /> Tracking Sheet nMir <br /> ) <br /> tt. <br /> fb`l 5� <br /> SPORS -- • . � <br /> ��u✓"w\ N(pTERIALS/DEVELOPMENT <br /> StorageMethod <br /> Contamination Noted - (y n) <br /> Storage Location Casing type TIVU <br /> Blank ft. Screen_-2k f- <br /> Slot size .0 <br /> GROUTING Bags cement <br /> Buckets bento a U 2 <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/siz <br /> Installation Method Surge Block: - C Y n <br /> Quantity Installed.2- Discussed with geo o ' c - y ) <br /> Type of merhod <br /> EH 29 29 <br />