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MONITORING WELL INSTALLATION REPURT <br /> Date: �' 7 � CONSTRUCTION <br /> Premise Address: 114 l Total Depth <br /> nL � 6Anz'T 7 Screen Length (from) t q (to) q <br /> Well No.: ►/�iy1�� P" — ?e �' O S Filter Pack (from) t 07 (to) <br /> Bentonite (from) (to)_ "7 <br /> Inspector: Grout (from) 1 (to) I <br /> Drilling rig type <br /> Permit No. Auger O.D.____&"` I. . <br /> Completion - Stove pipe/cliristie circle one) <br /> Drilling Company: L�1T7.1_� <br /> Driller: �( `�D(L _�__ cas; <br /> height <br /> Consultant V `� '4 <br /> Geologist ��I�,l,"TL.� K�11� •� T <br /> ABCVE-GaCUND <br /> COMPLETION C�itST'Y-80X <br /> COMPLEnCN <br /> SPECIAL PERMIT INFO. Ground Sumacs <br /> i.o <br /> Distance to sewer line <br /> proof <br /> Domestic well on site - (y/ n ) ll ft. <br /> If yes, location and distance - ft. <br /> -a <br /> P IT <br /> r <br /> SAMPLING �l�i cowed flute) <br /> •lorai <br /> :oc1cn <br /> Holding Temperature 4°C iV = gnv91 pack <br /> Method = <br /> Screening Method _ c =_ <br /> Tracking Sheet / n ) CRgin/ A - <br /> - = I Q ro ft. <br /> SPOILS Pa. — P i t> �S I Q <br /> xd <br /> Storage Method l->10t �'°r� MATERIALS/DEVEC.OPMENT <br /> Contamination Noted - (y/ n —.,-L 0j �, <br /> Storage Location n N S i ib Casing type SGt 4 '(-� �U C� a <br /> Blank} ft. Screen <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite V) bIXA(jer R7 <br /> Depth to water I bo®5 Bags sand/gravel T <br /> Mix Ratios Filter Pack type/size a /--1 <br /> Installation Method fiat fn,(— D(Z`f lto­:5- Surge Block: - &0 <br /> Quantity Installed Discussed with geologist: -y n ) <br /> Type of method `1J 60-El <br /> EH 29 29 <br />