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MONITORING WELL INSTALLATION REPORT <br /> Date: ` I LZ/ I O 0 CONSTRUCTION <br /> Premise Address: V C? /t) . (� o aLP� Total Depth 2 <br /> Screen Length (from) q (to)_3 2j <br /> Well No.: wt it_l— \ A- DYE V.i" Z-- Wl btl-cf Filter Pack Vrom)— (to) 3 z � <br /> Bentonite (from) 3 (to)_ S' <br /> Inspector. _! (��A���,w Grout (from) -s-- (to) 3 ' <br /> Drilling rig type <br /> Permit No. O o'a�l a I C7 Auger O.D. gz-Y,t I.D. <br /> Completion - Stove pipe/ (circl1.e one) <br /> Drilling Company: r.� �� <br /> Driller: casing <br /> height <br /> Consultant T_1 A,Aj--B —EWT <br /> - <br /> Geologist S2 of V�C a nJ" <br /> ABCVSGFIMND Cid[M-3oX <br /> COWLETICN COMPI- MCN <br /> SPECIAL PERMIT INFO. --Grourd S� <br /> Distance to sewer line grout <br /> Domestic well on site - <br /> If yes, location and di ce - ft <br /> q 0 <br /> C <br /> O <br /> SAMPLING torah <br /> tocicn — � <br /> Holding Teerature to •M <br /> m _ �aVo♦F <br /> Method <br /> Screening re thod r - <br /> Tracking Sheet - n ) `` __ <br /> — �- 11. <br /> SPOILS / <br /> Storage Method ��ntiV. MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( / n ) , <br /> Storage Location�y15, (r Casing type /"jj SIO Z 01111 <br /> Blank ft Screen_---L-5 s ft. <br /> Slot size . b LU <br /> GROUTING Bags cement <br /> Buckets bentonite 1 <br /> Depth to water N 1, ' Bags sand/gravel <br /> Mix Ratios Filter Pack type/size i <br /> Installation Method Surge Block: - (y/n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />