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MONITORING WELL INSTALLATION REP' T <br /> Date:_ �' Z!�d5 CONSTRUCTION <br /> Premise Address:_ 2%'(Z S v\_A ok-L, Total Depth S O <br /> Screen Length (from)_ 34 <br /> Well No.: 1'1/L Filler Pack (from)_ (to)_� <br /> Bentonite (from) 'Cl.-G (co) <br /> Inspector. _ I'_111A11C 4_,n Grout (from) (to) <br /> .Drilling rig type -- -- <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant `� <br /> _q,Geologist_ <br /> APA VE-G R C4_N D <br /> CG MP LE-T{O N Ck-A S7Y t30 X <br /> SPECIAL PERMIT INFO. cx=-X�Su taco <br /> Distance to sewer line Qra, <br /> Domestic well on site - ( _ft. <br /> If yes, location an ante - a <br /> — o <br /> C <br /> S AMP LI NG <br /> i to rad � <br /> Holding Temperature <br /> Method <br /> Screeninry od — <br /> :r = <br /> Trac Sheet - (y/ n ) =:' — <br /> � tt. = S <br /> � ft. <br /> SPOILS <br /> Storage Method ��Gc�,( o(n�_. MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y ) <br /> Storage Location_ ^s, <,; Casing type o1 ­Nc 5dV�Cqy <br /> Blank- 30 fr- Screen �• <br /> Slot size o e 0 <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water ^� 3 5� Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> installadon Method 46gdZ Surge Block: - ( y/ ii ) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29. <br />