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MONITORING WELL INSTALLATION REPO* <br /> Date: !� '� I //� q� CONSTRUCTION / <br /> Premise Address: YI�JV 5�, Total Depth <br /> Screen Length (from) Zf o (to) <br /> Well No.: AA>n J Filter Pack (from) (to) <br /> Bentonite (from)— (to) (o <br /> Inspector: 2 '�� Grout (from)-I,_ (to) <br /> iL-=T1CN7!; <br /> Permit No. I.D. 2 pip christie box (circle one)Drilling Company: 1��a1�Driller: b singightConsultantiGeologist CtW157'Y-8CX <br /> CCMPL CICN <br /> SPECIAL PERMIT INFO. Siafact <br /> } grout <br /> Distance to sewer line <br /> Domestic well on site - ( y/ n ) ft. <br /> If yes, location and distance - 1I ft. <br /> c <br /> 0 <br /> SAMPLING 310t <br /> wcion - <br /> b <br /> Holding Temperature BI Pack <br /> Method <br /> Screening Method <br /> Tracking Sheet - y n) <br /> t` .✓ <br /> SPOILS h <br /> Storage Method `>uYVl MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) TVL 60 <br /> Storage Location Casing type <br /> Blank---ZL_ft. Screen I ft. <br /> Slot size n I)10 <br /> GROUTING Bags cement <br /> I <br /> SBcykets <br /> ntoniteDepth to water ISA� U/ sgravel <br /> Mix Ratios <br /> installation Method Surge Block: - (y ) <br /> Quantity Installed Discussed with geolqst: -�` / n ) — <br /> Type of method dIM <br /> EH 29 29 <br />