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MONITORING WELL INSTALLATION REPORT <br /> Date: I z-I l`' 16 D CONSTRUCTION <br /> Premise Address: L-10 k'�, Gt fail Total Depth 32- �z1 <br /> Screen Length (from)— (to) L' z <br /> Well No.: Ulm Filter Pack (from) —(to) 3 z 1/7' , <br /> Bentonite (from)—�—(to)—T— <br /> Inspecton �Atnnncc" Grout (from) (to)—'T— <br /> Drilling rig type <br /> Permit No. Auger O.D. I.P. _ <br /> Completion - Stove pipe/ iristie bo: (circle one) <br /> Drilling Company: r fivoc.n -cj <br /> Driller. casing <br /> / height <br /> Consultant l:l/VQrLA VtC'Q 'cq--� V T <br /> Geologist CA ��an�Jt� _ ' — T <br /> ABOVEIaAC(1ND ChRZry-BOX <br /> COAiPLcTION COMPLTCN <br /> SPECIAL PERMIT INFO. G=nd SLrf 7— <br /> Distance to sewer line <br /> prcvt <br /> Domestic well on sit - ( y/ n ) `� ft <br /> It yes, location distance - j ft <br /> = o <br /> _= c <br /> SAMPLING slorai <br /> acc'cn — <br /> Holding Temperature rM i CW— <br /> Method <br /> tMethod a y� ��"Lnu <br /> Screening Method_Ln <br /> Tracking Sheet - ( y/ n ) _ <br /> — ` t2. <br /> SPOILS <br /> Storage MethodMATERIALS/DEVELOPMENT <br /> Contamination Noted - n ) <br /> Storage Location ain 5h EQ Casing We n J/ a c1t) Z PV CO. <br /> Blank 9r ft Screen oll`) ft. <br /> Slot size • b ly <br /> GROUTING Bags cement <br /> Buckets bentonite ° <br /> Depth to water iv Zzi Bags sand/gravel NI Z <br /> Mix Ratios Filter Pack type/size 1 I-L <br /> Installation Method Surge Block: - ( y n <br /> Quantity Installed Discussed with geologist: - ( y/(D <br /> Type of method <br /> EH 29 29 <br />