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4 � <br /> MONITORING WELL INSTALLATION REPOn f <br /> Date: N0✓ Z 2-00& CONSTRUCTION <br /> Premise Address: &— 9 /j/. m'r"►"t t Total Depth 45 <br /> .�( Screen Length (from) (to) Fb <br /> Well No.:--A 1 Filter Pack (from) (to)-9-7-- <br /> Bentonite (from)(to) 3S <br /> Inspector: Grout (from) �T (to) O <br /> p Drilling rig type_ E' <br /> Permit No. 5W DO 47J 70 o Auger O.D. �� I.D. 3 <br /> Drilling Company: <br /> � � dwzl_ A Completion - Stove pipe/christie box (circle one) <br /> Driller: /"Gl kms( f�`t� f casing <br /> nT height <br /> Consultant o s- <br /> Geologist <br /> ABOVE-GROUND <br /> OOWLEfION Gt4iISTY-BOX <br /> SPECIAL PERMIT INFO. Ground Saiacr <br /> Distance to <'57sZ6 line grout <br /> ara <br /> Domestic well on site - n ) 3$ <br /> ' ft. <br /> If yes, location Jr� llubc/ q0 tL <br /> n. <br /> = o <br /> — o <br /> SAMPLING tlorwd <br /> Holding Temperatur = yW pack <br /> Methods -" <br /> Screening Method <br /> Tracking Sheet - y n ) <br /> tt. <br /> SPOILS <br /> Storage Method "f SS.� [Ov" S�[s� MATERIALS/@EVELOPMENT <br /> Contamination Noted - (y,Q <br /> Storage Location 411� Casing type <br /> Blank !*2! ft. Screen j fr• <br /> Slot size •Q�/)A - <br /> GROLMNG Bags cement <br /> Buckets bentonite <br /> Depth to water �I / Bags sand/gravel <br /> Mix Ratios { O 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 />