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'v,oNITORING WELL INSTALLATION REPOR <br /> Date: �/ b6/1— CONSTRUCTION <br /> Premise Address: ° rIJ. L%"Z 5.'., W Total Depth <br /> 7 Screen Length (from) (to) <br /> Well No.: az Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: �p� �/tL Grout Moin) (to) <br /> Permit No. �IC- ��V 7 -- Drilling rig e <br /> Auger O.D. h I.D. <br /> � ffffn� Compl tion - Stove pipe/christie box (circle one) <br /> Drilling Company: �L''�•C. <br /> Driller: — casing <br /> height <br /> Consultant TL <br /> Geologist <br /> ABOVE GAC4j ) <br /> CO1.r'LET10N CHR STYWX <br /> COMPLETICN <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line(/J, —' - out <br /> Domestic well on site - ( y/ n ) <br /> If yes, location and distance - n• <br /> ft. <br /> ft. <br /> = a <br /> — o <br /> — o <br /> = m <br /> SAMPLING — o <br /> — � <br /> Holding Temperature ��/ — <br /> Method Temsac�on <br /> � <br /> Gni P <br /> Screening Method _— <br /> Tracking Sheet - y n ) — <br /> ft. <br /> SPOILS <br /> Storage Method `J&VUA M_ ATEW <br /> EVELOPMENT <br /> Contamination Noted - ( / n ) <br /> Storage Location__, Casin <br /> Blankft. Screen ft. <br /> Slot s <br /> GROUTING Bags <br /> S Buckeit <br /> Depth to water Y Bags sel <br /> Mix Ratios Filter e/s ze <br /> Installation Method Surge ( / n )Quantity Installed Discusgeologist: } / n ) <br /> Ty <br /> EH 29 29 pe of method <br />