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MONITORING WELL INSTALLATION REPORT <br /> Date: 1 LS 61 CONSTRUCTION <br /> Premise Address:_-__ `(2 S nl Total Depth_ 3 <br /> Screen Length (from) Z C (to)_�r� <br /> Well No.:_ m.w - h Filter Pack (from) o (to)_ 2 <br /> Inspector: _ ID -C I- Bentonite (from) (to)L� <br /> P Grout (from)_ <br /> Permit No._ L{C{1 3 Sa Drilling ng type <br /> Auger O.D. LD. <br /> Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company: c, <br /> Driller:_ 4WL) casing <br /> height <br /> Consultant L, IFn V <br /> Geologist_ To v-Y�,t �-1 <br /> ` l-°.O VE-G R CUN D <br /> CG MP L.ETiO N C---R LSTY-30X <br /> SPECIAL PERMIT INFO. end Su-fxY <br /> Distance to sewer line <br /> Domestic well on site - (y/ <br /> If yes, location and dis ce - It• <br /> ft. <br /> Y' q <br /> SAMPLING <br /> Holding Temperature cryN )'C— <br /> Method <br /> 'ri Method <br /> Screening Method P)O ''= — <br /> :r '- <br /> Tracking Sheet - rj/7r n ) <br /> I r 3 tt. <br /> SPOILS <br /> Storage Method 5-4 0n MATERIALS/DEVELOPMENT <br /> Contamination Noted - <br /> Storage Location_ ca& :i lb Casing type 2 '-fy(L <br /> Blank_ A ( ft. Screen ()—ft. <br /> Slot size . ozp _ <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to Nvater ^� �- 6 �S Bags sarnd/gravel <br /> Mix Rados Filter Pack type/size Z Z- <br /> d,nstallation Method Surge Block: - ( y/ n�T <br /> Quantity Installed -� Discussed vrith geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29. <br /> 1. <br />