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rAONITORING WELL INSTALLATION REPOn f <br /> f �ro CONSTRUCTION <br /> Premise Address: `! Total Depth l� <br /> Screen Length (from) (to) S <br /> Filter Pack (from)---= (to) <br /> Well No.:-A1L-)-- 1 <br /> ,- � — <br /> Bentonite (from) <br /> �(to) /FC <br /> Grout (from) <br /> Inspector. f A WS' �'t�^ Drilling rig type I <br /> pO� X Auger O.D. 2'N 2 <br /> Permit No. Completion- Stove pipe/ tie box Zdrele one) <br /> Drilling Company� _' <br /> n � { L casing <br /> /. <br /> Driller: , A � koV --- <br /> height <br /> j r <br /> Consultant � /iJ,�(j (7I�/£"{ <br /> Geologist- Lt l"e P (AAi;VEGRWNO CHMM-gOX <br /> CONPI.ITTION COMPtEnON <br /> Gfourd <br /> SPECIAL PERMIT INFO. ��- Satac+ —r. <br /> $LPd�c IA,vK grout <br /> Distance to sewer line-pit - <br /> Domestic well on site - Y/ n) ft. <br /> If yes, location and distance - ft' <br /> F, G t4 C s a ft. _ <br /> WF-; T — <br /> a <br /> G <br /> SAMPLING clotted .";. <br /> cac5on <br /> Holding,Temperature `'fes <br /> Method <br /> Screening Method NI <br /> Tracking Sheet - (Y/ n) 2 = t <br /> ft. <br /> SPOILS <br /> Storage Method 55 (gAl)oN ntQvtnS <br /> MATERIALS/ EVELOPMENT <br /> Contamination Noted - n <br /> ( 1 <br /> Storage Location Sn Cu�'A4 41" W+�'tt ! Blazmilcg tYPe h Screen <br /> �rrl - <br /> Slot size <br /> Bags cement _ <br /> GROUnNG Buckets ben ni e <br /> ' ����. Bags sand/gravel -- <br /> Depth to water <br /> Mix Ratios Y rwv� F riraN�'ivBE �2S wRfA Filter lock, - (size <br /> Surge Block: - (y <br /> Installation Method i ne $ `1S/I Discussed with geologist: - (� n) <br /> Quantity Installed Type of method <br /> EH 29 29 <br />