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MONITORING WELL INSTALLATION REPOnf <br /> Date: c t /3 24e95 CONSTRUCTION <br /> Premise Address: 17Y56 [/(R N Total Depth 5 <br /> //�,/ / Screen Length (from) (to) 3 <br /> Well No.: / <br /> Y�.w" Filter Pack (from) (to) 3 <br /> / Bentonite (from) (to) O <br /> Inspector: CEGG[.c-t'-p- Grout (from) (to) = L' <br /> cam, <br /> Permit No. 0 p i/2 r/j Drilling rig type 0 CIxE <br /> ovf 7 T l(J Auger O.D. I.D. <br /> Drilling Company: Completion tove pipe hristie box (circle one) <br /> l/ r( (,t1 <br /> Driller: 7`- <br /> casing <br /> // <br /> W height <br /> Consultant K Dp/�ycp� L <br /> Geologist C-&,� <br /> ABOVE-GROUND <br /> COMPLETION CHRISTY480X <br /> SPECIAL PERMIT INFO. COMPLETION <br /> Ground Solace <br /> Distance to sewer line � /JYEAk xq prart <br /> Domestic well on site - n ) <br /> If yes, location and distance - f1b - n. <br /> 5 n. <br /> n. <br /> — e <br /> SAMPLING — o` <br /> cloned — <br /> / � J tecton �- <br /> Holding Temperature_ /� _ <br /> Method — Gavel Pack <br /> Screening Method = <br /> Tracking Sheet - ( y/ n ) — <br /> 1¢Ln. rt. <br /> SPOILS <br /> Storage Method e MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y n " <br /> Storage Location s G&LW Casing type Lit �x k 4:> N(-7- <br /> Blank <br /> JeBlank ft. Screen Z0 ft. <br /> Slot size_ _Q2.0 <br /> GROUTING Bags cement_ I I <br /> } /00 Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios T u//��, y� Filter Pack type/size tt -:5 <br /> Installation Me od 4elf dW44a SF e�oep /i.y Surge Block: - (y n® <br /> Quantity Installed 'SS Discussed with geo)ogist: - (y <br /> EH 29 29 Type of method <br />