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MONITORING WELL INSTALLATION REPOti f <br /> Date: �L .� U/ CONSTRUCTION <br /> Premise Address: E_ 121 Total Depth Xl C <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) 71-0 <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type S <br /> Permit No. 70((J 7 Z Auger O.D. I.D. <br /> JEG=rd <br /> /christie box (circle one) <br /> Drilling Company: <br /> Driller: Z g <br /> ConsultantGeologistCtiAiSTY-80X <br /> COMPLE71ON <br /> SPECIAL PERMIT INFO. Surf acs <br /> Distance to sewer line <br /> Do stic well on site -�n ) (� ft 4 <br /> I yes, location and distance - fAd , <br /> �y <br /> ft. <br /> r 3-73 <br /> SAMPLING = <br /> �lottad � �(�O <br /> saCion = <br /> 73 -76 <br /> Holding Temperature 7,V9,Pack <br /> Method —' <br /> Screening Method <br /> Tracking Sheet -On ) 2` <br /> 7 <br /> SPOILS <br /> pp �oS <br /> Storage Method L MATERIALS/DEVELOPMENT <br /> Contamination Note - (y L� <br /> Storage Location Casing type <br /> Blank y5 ft. Screen h• <br /> Slot size .0/0 <br /> GROUTING Bags cement 8 <br /> `/ / \/ Buckets bentonite <N <br /> Depth to water E /1�1rs'u� U k L� Bags sand/gravelTWMix Ratios ZFT Filter Pack type/s <br /> Installation Method Surge Block: - ( <br /> Quantity In <br /> stalled oU Discussed with geologist: - (ye) <br /> Type of method <br /> EH 29 29 <br /> /I art r t <br /> aA /21(o Aa-^t <br />