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MONITORING WELL INSTALLATION REP T <br /> Date: 1 a' l 4P2, 2 l ek 1 07 CONSTRUCTION <br /> Premise Address: m��a1 �`�'"� Total Depth 30 <br /> �� 2 Screen Length (from) 3 O (to) <br /> Well No.: ITS Filter Pack (from) -2 n (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from (toj <br /> Drilling rig type WS <br /> Permit No. Q8,�2'$�0� Auger O.D. � ' I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant VV- <br /> � -�• <br /> 11 <br /> Geologist •T! VV- M- �� •� T <br /> ABOVE-GROUND CHR15 4? CX <br /> COWLEf IO N COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line proof <br /> Domestic well on site - (y/n ) ft. <br /> If yes, location and distance - ft• <br /> ft. <br /> A <br /> C <br /> O <br /> SAMPLING slotted <br /> o sec�on <br /> Holding Tem erature = pnvd Pacts <br /> Method 64 <br /> Screening Method .= <br /> Tracking Sheet / n ) <br /> SPOILS -30/ <br /> Storage Method !'ti MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y n /I ((v <br /> Storage Location Casing type <br /> Blank 7 S'_ ft. Screen ft. <br /> Slot size M O[O <br /> GROUTING Bags cement 7,�? <br /> N Buckets bentonite__Zbt e <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/sieogist: <br /> L <br /> Installation Method Surge Block: - (yQuantity Installed Discussed with ge - v/ n ) <br /> Type of method <br /> EH 29 29 <br />