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ONITORING WELL INSTALLATION REPO.O <br /> Date: S� 7GvZ CONSTRUCTION <br /> Premise Address:,? /�+5p i r y tU Total Depth 2�0 <br /> /M p Screen Length (from) Z3 o (to) Z/D <br /> Well No.: pla/ — D Filter Pack (from) 7 ?0 (to)�� <br /> Bentonite (from) zoo (to) J5575 <br /> Inspector: �� N`b Grout (from) /76- (to)__:�L_ _ <br /> Drilling rig type w <br /> Permit No. Auger O.D. I.D. <br /> Completion cove pipe/cl istie box (circle one) <br /> Drilling Company: <br /> Driller._ TM77- height <br /> casing <br /> Consultant �/�T/c2�- . -i- <br /> Geologist \I b e - T <br /> ABOVE-GROUND C>4iISiY 80X <br /> COMPLE?lON COMPLETION <br /> SPECIAL PERMIT INFO. Gro+rd Saiac� <br /> Distance to sewer line trout <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - ft. <br /> � v m <br /> Y <br /> SAMPLING alorad <br /> sacicn = <br /> Holding Temperature — pavd padt <br /> Method <br /> ^n <br /> Screening Method <br /> Tracking Shcet - (y/ n ) x` <br /> }t. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) r r <br /> Storage Location Casing type 2- <br /> Blank <br /> Blank ft. Screen h. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water �LZ IS Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - ( y/ n ) <br /> Quantity Installed - �_ Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 I7fl <br />