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MONITORING WELL INSTALLATION REPO* <br /> Date: /'� -) CONSTRUC'T'ION \\ <br /> Premise Address: TWD LQt (i1L(iy�J Total Depth 35 �2'1 SGRI ��fa 1 <br /> Screen Length (from) - (to)I <br /> � <br /> Well No.: }�w I Filter Pack (from) (to) !I <br /> Bentonite (from) °T (to) <br /> Inspector: &6A _ Grout (from) ' _(to) <br /> Drilling rig We <br /> Permit No. Auger O.D. I.D. <br /> Completion tove pip christie box (circle one) <br /> Drilling Company: S�Yy>IfN/h/I <br /> Driller: i�iY'I 7 casing <br /> / eight <br /> ConsultantVVT <br /> Geologist U� I ��iRfJt� AgpyE-GA D C4-SCN-aox <br /> CCAF ICN CCMPLET1CN <br /> SPECIAL PERMIT INFO. mac <br /> Sus <br /> Ott <br /> Distance to sewer line <br /> Domestic well on site - (y/ n ) ft. <br /> If yes, location and distance - ft. <br /> _ '3 <br /> a <br /> m <br /> C <br /> O <br /> SAMPLING $ <br /> Holding Temperature <br /> Method ?` <br /> Screening Method <br /> Tracking Sheet - y/ n) <br /> SPOILS �— <br /> Storage Method 1 Yfil)� / MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ ) Casing type ?k/L 5C i£ <br /> Storage Location n119�I1V/ Blank 13�— fr. Screen I ft. <br /> Slot size 0,010 <br /> ant <br /> GROUTING <br /> bentonite <br /> Depth to water I,l f Vv (/. 9ack <br /> n gravel <br /> type/size <br /> Mix Ratios <br /> Installation Method Surge Block: - (yam <br /> Quantity Installed Discussed with geologist: n) <br /> Type of method <br /> EH 29 29 <br />