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r MONITORING WELL INSTAUAnON REPO',- <br /> Date- <br /> EPOiDate: a-95 CONSTRUCnON <br /> Premise Address: (00 S � �� Total Depth 29 <br /> l <br /> Screen Length (from) (to) <br /> Well No, W IC�� Filter Pack (from) Z „---`(to) <br /> Bentonite (from) - ^(to) -57 <br /> Inspector. Grout (from)„-„ (to) -6 <br /> Drilling rig type <br /> Permit No, Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company-, <br /> Driller: VC�.✓1�� Q� casing <br /> r <br /> height <br /> Consultant <br /> 1v ;' <br /> Geologist_To Y)n' �V _ T <br /> ABOVE-GACUND CNRMry-SOX <br /> GOMPLETCN COMPLETION <br /> SPECIAL PERMIT INFO. G=nd Sufi <br /> Distance to sewer line gta�t <br /> Domestic well on site - (y/n ) it. <br /> If yes, location and distance - <br /> Q It. <br /> Y <br /> � C <br /> SAMPLING o <br /> s#dcn sr <br /> Holding Temperature :N <br /> Method In QM Pack <br /> Screening Method T. <br /> Tracking Sheet - (y/ n ) — <br /> SPOILS <br /> Storage Method Q }CX.� p�`� MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/Q) 2 `` P C. <br /> Storage Location. 9NL�(d Casing type <br /> Blank ft. Screen ft. <br /> Slot size - o t O <br /> GROUTING Bags cement I — <br /> Buckets bentonite i- <br /> Depth to water 4 Bags sand/gravel 2 [ S - <br /> Mix Ratios lam' t-s uc c�.tet- c,��_ Filter Pack type/size <br /> Installation Method_ r1E— Surge BIock: - (y/(f5 <br /> Quantity Installed Discussed with geologist: - (y/41a] <br /> Type of method <br /> EH 29 29 <br />