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MONITORING WELL INSTALLATION REPur�T <br /> Date: �' (� r CONSTRUCTION <br /> p� ' l i <br /> Premise Address: I 00oND Total Depth ID <br /> Screen Length (from) ?A (to) <br /> Well No.: Y ►ln)` -qwv MLo- S Filter Pack (from) QD_(to) <br /> Bentonite (from) LA (to) <br /> Inspector: - V Grout (from) (to) <br /> C�1��r ?( Drilling rig type <br /> Permit No. J � Auger O.D. I.D. <br /> --� Completion - Stove pipe/christie box (cir a one) <br /> Drilling Company: <br /> Driller: casing <br /> I Ir77 <br /> height <br /> Consultant 'lEU P�i�li <br /> Geologist 0--, <br /> A3CVE.3RC(jND CC&F'_7;CN <br /> SPECIAL PERMIT INFO. C-X=nd Sulacs <br /> Distance to sewerline grocrt <br /> I <br /> Domestic well on site <br /> If yes, location and distance - <br /> a <br /> e <br /> s <br /> _ <br /> SAMPLING <br /> �0� aoccon - <br /> Holding Temperature = 72w1 pack <br /> Method <br /> Screening Method V _ <br /> T racking Sheet n ) <br /> SPOILS ' <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - y/ n/) MVM- — 0� f� p�� �1 Q U <br /> Storage Location a -SI Casing type <br /> OIL, Blank ft- Screen I ti <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Yfix Ratios 1-S ) la 9�1 b0 s ix Filter Pack e/size <br /> Installation Merhod� w Surge Block: - ( n ) <br /> Quantity Installed SfN4 g Discussed with Iogist: - y/ a ) <br /> Type of method <br /> EH 29 29 <br />