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MONITORING WELL INSTALLATION REPO", <br /> Date: 042— CONSTRUCTION <br /> Premise Address: �L?Od "� Total Depth l <br /> Screen Length (from) 7,90 -(to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector. l Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: <br /> L Completion - Stove pipe/cluistie box (circle one) <br /> Driller: casing <br /> 7_ height <br /> Consultant Z11/e5 '9 _qVT <br /> Geologist •-P/ <br /> ABOVE-G R CUND CI^W ZTY-30X <br /> CO WPLET{ON COMPLEMCN <br /> SPECIAL PERMIT INFO. Grourd Suiaaa <br /> 8 C�dUC"l� ` <br /> Distance to sewer line orart <br /> /Q�0 ,t <br /> Domestic well on site - (y/ n) -f-p 5�t�65 �' ft. <br /> If yes, location and distance - ft. <br /> ft. <br /> _ o <br /> SAMPLING •loroi _ <br /> Holding Temperature <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n ) Y <br /> ft. <br /> SPOILS <br /> T� 7a' �."P✓L <br /> Storage Method MATERIALS/DEVELO MENT <br /> Contamination Noted - (y/n ) W <br /> Storage Location Casing type �`m��-T`nr- S�, <br /> Blank ft. Scr en Uft. <br /> Slot size 0.0 7-0 <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size 7 <br /> Installation Method Surge Block: - ( y/n ) <br /> Quantity Installed Discussed with geologist: - (Y) n ) <br /> Type of method <br /> EH 29 29 <br />