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MONITORING WELL INSTALLATION REPORT <br /> Date: �7 �� CONSTRUCTION <br /> Premise Address: l00 -� - �{� Total Depth VY <br /> //-- ,�— Screen Length (from) (to) <br /> Well No.: ��'''G✓lo/e "4 w 7 <br /> lc,-��cns�^••� ilter Pack (from)_ 47K— <br /> _(EO) <br /> v p Bentonite (from) (to) <br /> Inspect-on Grout (from) (to) <br /> Drilling rig e <br /> Permit No. Auger O.D. 67y I.D. <br /> pp QQ Co on - pipe/cluistie b x (circle one) <br /> Drilling Company: l�C -bx <br /> Driller: �`casinq • <br /> height <br /> Consultant (?,!�' <br /> S�/►r � v II'. —q\ VT <br /> Geologist <br /> • \AP E-G R CQN'b <br /> CO k�'C_.�`t"!O N �^�,,� _b R Ct,A:si Y-3oX ' <br /> \ CC+APL_=T1CN <br /> SPECIAL PERMIT INFO. G=nd gzf,cs <br /> Distance to sewer line Ora <br /> Domesticwell on site - (y/ n) I $ ��+•*�����` <br /> If yes, location and distance - <br /> ay eft. <br /> M <br /> _ n <br /> C <br /> SAMPLING ^: — <br /> ilora.� <br /> '/ soden — -� <br /> Holding Temperature VOL <br /> Method ,�� <br /> Screenlno Method <br /> Tracking Shcet - ( / n ) <br /> ft. tt. <br /> SPOILS <br /> Storage Method � J MATERIALS/DEVELOPMENT <br /> Contaminadon Noted - (y,/ n ) N <br /> �� <br /> Storage Location D1.�S Casing type (� <br /> Blank ft- Screen Zv ft. <br /> Slot size O-OZU <br /> GROUTING Bags cement <br /> Buckets bentonite / �b <br /> Depth to water Bags sand/gravel <br /> Mix Rados C e Filter Pack type/size ,? <br /> d,lstal[aEon Method � a Surge Block: - ev 11 ) <br /> Quantity Installed - Discussed with geologist: - n_ <br /> Type of method — <br /> EH 29 29. . <br />