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MONITORING WELL INSTALLATION REPOnT° <br /> Date: CJ'x-10) CONSTRUCTION <br /> Premise Address: U�2 `(O,SEM I T Total Depth_j / <br /> Screen Length (from) l .1i (to) `1 <br /> Well No.: Yh00 I 2 30 Filter Pack (from) l (to) <br /> Bentonite (from) (to) --I <br /> Inspector: �n��; Grout (from) `l (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. R I.D. - 25 <br /> �� Completion - Stove pipe/clnristie box (circle one) <br /> Drilling Company: C-)I(,l, <br /> Driller: �(J,��/IJ12 casing <br /> height ` <br /> Consultant Q (" <br /> 7//, <br /> Geologist ubla� <br /> ABCVE-GACUND <br /> CONFLETION CCMPLETICN <br /> SPECIAL PERMIT INFO. Ground Su-facs <br /> Distance to v VA grout <br /> Dffaeswell on site - n ) �ft. <br /> If yes, location an istance - <br /> m <br /> _ a <br /> SAMPLING — <br /> ,tascicn — <br /> Holding Temperature oc- tit " <br /> Method <br /> = pav�1 <br /> Screening Method k�1 ;r <br /> Tracking Sheet -(�V n UD CU UO a'( <br /> fL <br /> SPOILS <br /> Storage Method bl W — C1&&-Tt*g ej6Q i MATERIALS/DEVELOPMENT <br /> Contamination Noted -J n ) 0 <br /> Storage Location N Casing type 5ct-k 4D PV'C- 2 <br /> Anfl�l5 ES Blank 9 ft. Screen t O ft. <br /> Slot size Co. as 0 <br /> GROUTING Bags cement <br /> I Bu s bentonite % bUGk.c;T ptTZ. (13ELC- <br /> Depth to water k S Bags san gravel <br /> Mix Ratios - Filter Pack type/size 2�1 <br /> Installation Method -SJ Surge Block: - (&')/ n ) <br /> Quantity Installed Discussed with geologist: -f& n ) <br /> Type of method b9,U.G'IZS <br /> EH 29 29 <br />