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MONITORING WELL INSTALLATION REPO-r' <br /> i <br /> Date: CONSTRUCTION <br /> Premise Address: 24)41 * in Total Depth <br /> Screen Length (from) ­70 (to) S6 <br /> Well No.: AAW- Filter Pack (from) 1 (to) S 4 <br /> Bentonite (from) S 4 (to) 5 Z <br /> Inspector. S Grout (from) S Z (to) I <br /> Drilling rig type '$-U ' <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company: <br /> Driller: 1, 62 casing <br /> height <br /> Consultant 1�SI✓ '4 '4' <br /> Geologist -- <br /> AEFO E.GACUND <br /> COMPLETION COMPLEEMCN <br /> SPECIAL PERMIT INFO. Ground Surlwo �•�� <br /> Distance to sewer line Oz <br /> grout <br /> Domestic well on site - (y/ n) ft. <br /> If yes, location and distance - <br /> SAMPLING <br /> Holding Temperature <' <br /> Gjr iY9l Pack <br /> Method <br /> Screening Method 1 -_ <br /> Tracking Sheety n ) CAir,w c1' Gvsriy�/ -. — <br /> T10 <br /> tt. <br /> SPOILS <br /> Storage Method t71N ' �_ MATERIALS/DEVELOPMENT <br /> Contamination Not d - y/n) -M ,'v <br /> Storage Location Casing type '664J <br /> Blank '2 ft. Screen Pti ft. <br /> Slot size <br /> GROUTING Bags cement " <br /> Buckets—bentonite " 12 <br /> Depth to water I'D Bags san gravel Tl� <br /> Mix Ratios ack type/ ' e ?//1 -7 <br /> Installation Method '(��G Surge Block: (y nr <br /> Quantity Installed Discussed with eologist: - / n <br /> Type of method 1���,t l,F. kAxi-/- <br /> EH 29 29 <br />