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MONITORING WELL INSTALLATION REPOtn f <br /> v <br /> Date: Z3 > CONSTRUCTION <br /> Premise Address: �L �U �V. !/� �" -Total Depth 6� <br /> _ - Screen Len from <br /> Well No.: lit/ S -_ -- Filter Pack (from) <br /> Bentonite (from) (to) 3& <br /> Inspector: Grout II (from) (0 (t 0) 5 <br /> r` (� Drilling rig type Gra.E 8� <br /> Permit No. 7II[ Auger O.D. _--(O I.D. to <br /> Completion - Stove pipe/christie box (circle one) <br /> I` <br /> Drilling Company: <br /> t Z I� <br /> Driller: �� r casing <br /> height <br /> Consultant <br /> T � <br /> } _ T <br /> Geologist d s <br /> ,R901/E-r ROUND <br /> COtiPLE C[Ot! C�fR�STY-BOX <br /> GAdPLE�iON <br /> SPECIAL PERMIT INFO. Ground Sur wo <br /> . i <br /> Distance to sewer line ` , grout <br /> 36 <br /> Domestic well on site - (y n <br /> n. <br /> If yes, location and distance - tL <br />{ SAMPLINGY �J ,.slat�ad ;� <br /> ' <br /> �'-$ ' <br /> Holding Temperature k <br /> Method I <br /> Screening Method <br /> Tracking Sheet - y nfL <br /> ) <br /> •� ' ' <br /> .4 SPOILS r " r,��J ' " '�. :ccs : .+N} t <br /> ` Storage Method` ��� //'[.�w'� MATE RIALS/DEVELOPMENT <br /> a a Contamination Noted - y n ) p 4V <br /> j, _ <br /> Storage Location. '��� 5��U4-,)l Casing type <br /> Blank ft. Screen <br /> -730 <br /> SI'ot sizeir fol v <br /> GROU TINGBags cet ient 4 Bio <br /> t <br /> Buckets bentonite # <br /> { ' Depth to water Bags sard/gravel / <br /> Mix.Ratios S Filter Pack type/size `' 7- } <br /> C-1\ Of <br /> Installation Method '� Surge Block:`- (y ` <br /> aE <br /> tw- <br /> quantity Installed 'Z.�• � '* _'* *� � �`� �'�Discussed with,-geologist: (D n.) <br /> 4 Type,oE nethod <br /> t EH 29 29 <br /> �� � it �a. • `3 �" <br />