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{ MONITORING WELL INSTALLATION REPORT <br /> Date: I�-I 'j I CONSTRUCTION <br /> Premise Address: Z`I S a I-OS 6 Total Depth Ib <br /> Screen Length (from) [L ` (to) I <br /> Well No.:_ Q 6J -�o Filter Pack (from) 10 (to) <br /> Bentonite (from) (2 (to) ld <br /> Inspector: tnnge gild Grout (from) (to)�o _ <br /> Drilling rig type <br /> Permit No. 6 y Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: L-J f t /� 6atwo�oatlnovf <br /> I <br /> Driller: 9-r7�}t_�r 5casing <br /> ,. height <br /> Consultant AL7 E <br /> Geologist . V26IW-A AA t ( ( MA ej. - <br /> ABOVE-GROUND CNAISIY-sox t <br /> COMPLE-r10N COMPLETICN <br /> SPECIAL PERMIT INFO. Ground Serfxs <br /> Distance to sewer lineQfO� <br /> Domestic well on site _ <br /> If yes, location and ance - <br /> 1z n. <br /> 4rZ ♦`f. 1 y ! ♦ q jJ`.t.'%•t .. { .1..t�Y - i' -I { 4-i�.�' .,�.t"y r� m r _ <br /> SAMPLING <br /> ilo Clad � - <br /> &acdon = <br /> r „I, Holding Temperature: a n `t�� <br /> Method 6.. �r�ewe 5(__tee '� • k — J P <br /> Screening.Method <br /> ` t Tracking Sheet - ( y/ n) . " — <br /> � 8 n. — <br /> ,,SPOILS; r� ,_nom. w" ��, -. e , � t a, �� a i•. '•` �' - . <br /> i <br /> 4 Storage.tvle llod S .,r NIATERIALS/DEVELOPMENT <br /> Contamination Noted - n <br /> -/_) f . <br /> ,'Storage Location '�yy_�, _ Casing type �I- VC, <br /> Blank (Z ft: Screen - Z ' H <br /> zz�� ♦*.. _:- .,, `* _-Y n a _ Slott size, <br /> G- ,•-nn__�tnm�r _ < .-<r �- <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water N Bags sand/gravel SrGtn♦.o�f• <br /> { Mix Ratios. ' 2O Filter Fuck type/size <br /> Installation Method Surge'Blockr - ( y/ ) <br /> Quantity Installed Discussed with geologist: - ( y <br /> • � ! '- .< - Type of method <br /> EH 29 29 <br /> x <br /> s c., A, - <br />