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� MONITORING WELL INST TION REI•�.�tT <br /> { <br /> I <br /> Date: r CONSTRUCTION <br /> Premise Address: <br /> — i Yoe w\s-�-� Total Depth <br /> / { Screen Length (from) (to) <br /> Well No.: r ( Filter Pack (from) 2c) (to) - <br /> �� Bentonite (from) (to). <br /> Grout (from) <br /> Inspector• j r7 Drilling rig type I <br /> Auger O.D. I.D. Lr <br /> Permit No. <br /> Z 4 <br /> L <br /> Drilling ComPanY:_ O <br /> E "14C'_1 <br /> ;'` <br /> Driller: casing_ height <br /> { SCS ♦ . <br /> Consultant -r; <br /> Geologist AgpyE.Oppp <br /> CQt�LETfON Ci-(FitS"fY-8CX <br /> COMPLEMNt <br /> SPECIAL PERMIT INFO. Ground Surface <br /> grout <br /> Distance to sewer line <br /> Dom�e}stic well on site n ) r Z g_ <br /> DyY-1'I�locati n an dis ce - <br /> 10 <br /> } .A slottad r <br /> SAMPLING Oi G(t { fQ"�" J soc5an <br /> Hoidin Tempera e 1 — p �staW�� gm's� <br /> g P - A I <br /> Method '` <br /> Screening Method "" r <br /> Tracking Sheet n ) : <br /> L D"I fL w = L I20 tt. <br /> _.�... <br /> SPOILSf <br /> 5 � d) <br /> Storage Method jk'u VA [ (teMATERIALS EVELOPMIJNT, <br /> QContamination Noted - (y <br /> 6 f Stor ge Location ( ` Casing type !/ <br /> 2G S Blank ft. Screen ft- <br /> r`',► Slat size ®l U <br /> 6 Bags cement <br /> GROUTING <br /> i �b c Bu a ben nfe W - --- <br /> Depth to water r` 'd"''Z+b el <br /> De <br /> P �'�'`y er a type/ ' e <br /> Mix Ratios <br /> Installation Method M�1- i S - p E c� G ge Block: - y n <br /> Quantity Installed 'z- iscussed wi logist: n)d r(,,rf <br /> Type of method <br /> - --- f <br /> EH 29 29 0 KIA _ -I ; <br />