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r � <br /> MONITORING WELL INSTALLATION REP-,KT <br /> Date: /U .L --1&) <br /> CONSTRUCTION <br /> ?remise Address* U41? / Total Depth 2-6 <br /> —,-- <br /> Screen Length (from) (to) <br /> Well No.: ZIAI_� Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> inspector. \ _ __ __ _ _ Grour (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.O. <br /> Completion - Stove pipe/du-istie box (circle one) <br /> Drilling Company: <br /> f <br /> Driller. Cas Lng <br /> height <br /> Consultantri���-t. <br /> Geologist -- <br /> ABCV=--GRCXJND <br /> Grl.g�.cCSgN <br /> 0-SZ-1 Y_aCX <br /> C--A'+dPL'T,CN <br /> SPECIAL PERNUT INFO. G=nd Shia= <br /> Distance to sewer line <br /> Domestic well on site - ( y/ n } <br /> Vol <br /> If yes, location and distance <br /> — o <br /> e <br /> d <br /> SAMPLING dctwd b: — <br /> LPC�Ct3 - 3 <br /> Holding Temperature ;n�w Pack <br /> " <br /> :Method FF <br /> Screening Method _ <br /> Tracking Sheet - ( y/ n } — <br /> ;i. <br /> SPOILS <br /> Storage Method MATERIALS/UEVELOPNVfENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type <br /> BIank ft. Sween ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonire <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist; - (y <br /> Type of mediod <br /> EH 29 29 <br />