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r" <br /> MONITORING WELL INSTALLATION REPORT <br /> Date:h b 1 t CONSTRUCTION <br /> I <br /> Premise Address: Z,4 -S;-0 'Tc;,-Jr, R.a / -T^tArk- Total Depth <br /> U Screen Length (from) V5 (to) / S <br /> Well No.: U (A).� OW Filter Pack (from) 11 t (to) 1jr, <br /> Bentonite (from)—(to)— <br /> Inspector: <br /> from) (to)Inspector: �tAAACCrtt— Grout (from) (to) <br /> Drilling rig type <br /> Permit No. (o l`B 1 K Auger O.D. I.D. <br /> Completion Stove pipe/christie box (circle one) ' <br /> Drilling Company: mt w(VA!(0aYt6,t`crt,tvAdA <br /> Driller:- Rp)?� S (Gt casing <br /> height <br /> Consultant /drCcaL� <br /> Geologist F�fllld to 41/1 l (�Nnei - <br /> ABOVE-GRCUND CNAISrY-BOX <br /> COA�LETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line grout <br /> 1 <br /> Domestic well on s' - ( y/ n ) 1 <br /> If yes, loca[io d distance - �, <br /> 13 _ <br /> — m <br /> c <br /> SAMPLING <br /> glortad = c <br /> aacacn = � i, <br /> C,;,r Holding Temperature <br /> t k <br /> Method (2 (11MZr.2 <br /> Screening Method <br /> Tracking Sheet - ( y/ n ) _ <br /> SPOILS. <br /> t <br /> Storage Method S� .tn -g ��, 'MATERIALS/DEVELOPMENT',, L <br /> Contamination Noted - n ) t , 1 <br /> Storage Location $ereen•;Y� -.. • -•, t Slot size-P?Casing <br /> 3 ' r tftr v`oZ. r fl <br /> s $ <br /> Blank <br /> y <br /> IM l cnry 17�Y—( <br /> GROUTING ` } ' Bags cement <br /> Buckets�bentonite t <br /> Depth to watert Bags sand/gravel <br /> Mix Ratios_ �1 -tNO �_1_ Filter Pack type/size <br /> ` Installation Method rOertnn.a Surge Block: - ( y/0 <br /> Quantity Installed Discussed with geologist: - ( y/Q) <br /> { ''• c- t} r a s n"` i Type of method <br /> EH 29 29 <br /> tr: r <br />