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MONITORING WELL INSTALLAn'nf4 REPORT <br /> Date:_ 'v-\ 7 <br /> nn CONSTRUCTION <br /> Premise Address:— C�. WW Total Depth <br /> Well No.: Screen Length (from)' (to) <br /> Filter Pack MOM) — <br /> (to) <br /> Inspector: ��- r1 �p�(,�'1w,� Bentonite' (from) (to) <br /> Grout (from) (to) <br /> rh <br /> Drilling rig type <br /> Permit No. Auger O.D. <br /> /�` Completion- Stov <br /> Drilling Company:_ e pipe/ •'stie box circle one <br /> f r�++ E l <br /> Driller:_ _�Q C L w <br /> casing <br /> Consultheight: <br /> ant_ Q- (� <br /> t <br /> Geologists <br /> . A80VE-GROUND <br /> CoWLET1oN -BOX - <br /> SPECIAL PERMIT INFO COMPLETION <br /> _ I Ground Surface <br /> Distance to sewer line ��l 0rout <br /> Domestic well on site . (y/n) <br /> If yes, location and distance - _R <br /> ystt 'A3 tt. <br /> SAMPLING <br /> 0 <br /> 2 abttad <br /> Holding Temperature JZ aac�an <br /> Method L <br /> • �^ — vnwl Pacfc <br /> Screening Method <br /> Tracking Sheet - y n) <br /> SPOILS <br /> SY` p"t <br /> e ys y <br /> Storage Method On) <br /> Contamination Noted - MATERIALS/DEVELOPMENT <br /> Storage Lo cation o$tS!`L Casing type_ C <br /> Blank b <br /> Screen---!-- <br /> Jg• <br /> GROUTING Slot size <br /> r Bags cement <br /> Depth to water 3 T Buckets bentonite <br /> Mix Ratios �w'�c1 5 Bags sand/gravel <br /> _ <br /> Iz Filter Pack type/size <br /> Installation Methoddnn <br /> QuanthyInstalled ------- S geBlock:_Cy_/ <br /> Discussed with geologist: <br /> EH 29 29 Type of method <br />