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MONITORING WELL INSTALLATION REPUKT <br /> Date: 3CONSTRUCTION <br /> Premise Address: 2,6-)Z VcS—rn c ?Gs Total Depth <br /> Screen Length (from) —1 n (to) <br /> Well No.: ynuj- 1 I Filter Pack (from) 7 0 (to) S� <br /> Bentonite (from) SSS (to) <br /> Inspector: Grout (from) Sa (to) 1-O <br /> Drilling rig type 0-41 <br /> Permit No. Auger O.D. I.D. <V i <br /> Completion - Stove pipe/cliristie box (circle one) <br /> Drilling Company: Q lLt7,(1 <br /> Driller: ( __ casing <br /> height <br /> Consultant FFI] <br /> Geologist •- <br /> T ABCVE-Ga0uN0 cHRLSTY = <br /> // COWLFTICN C N <br /> _SPECIAL PERMITAFO. Ground Sumacs <br /> Distance to sewer line <br /> proof <br /> I/ <br /> Domestic well on site - (y/ n ) ft. <br /> If yes, location and distance - ft- <br /> SAMPLING <br /> L <br /> soccicn A = <br /> Holding Temperature a�-I - <br /> Method = pave F <br /> ack <br /> Screening Method c __ <br /> Tracking Sheet - ( y/ n ) '' —_ <br /> --1.0_tt. = O fL <br /> SPOILS <br /> Storage Method Q/ti - 0 Fr-HAU t- MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y 4D <br /> Storage Location 6u 5 LTg Casing type 5C-" ' <br /> Blank ft. Screen I S ft. <br /> Slot size D. Oa O <br /> GROUTING Bags cement <br /> Buckets bentonite 1 <br /> Depth to water I�� Bags sand/gravel <br /> Mix Ratios Filter Pack type/size 5T� <br /> Installation Method 71 ,E n ti;-: Surge Block: - q!T/ n ) <br /> Quantity Installed Discussed with geologist: - 6:�)n ) <br /> Type of method 43(z 13 A4 L&Z- <br /> EH 29 29 <br />