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MONITORING WELL INSTALLATION REP04 <br /> Dace: S O j CONSTRUCTION <br /> g <br /> Premise Address:—J js js { /y _ Y �1 f Total Depth S <br /> Screen Length (from) 3 5 (to) - <br /> WeII No.: Filter Pack (from)_ 3 _(to) � S <br /> Bentonite (from) 33 I (to) s �- <br /> Inspector. _ {.[��e,•c•� Grout (from) �O {to) 3 I w <br /> Drilling ng TYPe <br /> Permit No._ . [7AuerS 2,4' t - ----- Auger O.D. I.D. <br /> Completi - Stove pipe/cluistie box (circle one) <br /> Drilling Company C <br /> Driller: casing <br /> height <br /> Consultant 'a <br /> Geologist EjU 'C' -- <br /> V V ABOVE-GaCUND 0-iszTY-aOx <br /> CO WLETON cwt-mcN <br /> SPECIAL PERMIT INFO. Ground Sumac* <br /> grout <br /> Distance to sewer line P1 <br /> Domestic well on site - ( y/ n ) •7 3 I ft. <br /> If yes, location and distance - 32 <br /> - <br /> r <br /> i r <br /> C <br /> SAMPLING <br /> aloft" <br /> soden <br /> Holding Temperature pavd wds <br /> Method <br /> Screening Method <br /> Tracking Sheet - ( y/ n ) — <br /> SPOILS <br /> Storage Method MATERIALS EVELOPMENT <br /> Contamination Noted - ( y/ n ) <br /> Storage Location Casing type 2- <br /> Blank fL Screen <br /> Slot size 0 I d <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/graveI <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - ( y/ n ) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />