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MONITORING WELL INSTALLATION REPOttf <br /> Date: 7 ' G I l CONSTRUCTION <br /> Premise Address : 1050 aja' / Total Depth <br /> n A 1 Screen Length (from) 103.01 (to) <br /> Well No. : AA 1A Filter Pack (from), , J6 ,! o) <br /> JJJ Bentonite (from) (to)S o <br /> Inspector: ��X i Grout (from). l <br /> Drilling rig type <br /> Permit No. Auger O.D._ I.D. tw7 <br /> 1GWh lO*A Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: 1U/tib <br /> Driller: � L" AytyA , casing <br /> height <br /> Consultant �i)YI Pod <br /> 1 Geologist pgpyE{;ACUND <br /> COMPt.ETION IX <br /> COMPUTICI.ETICN <br /> SPECIAL PERMIT TNFO. q� Ground Surtact <br /> Distance to server line gfOtA <br /> Domestic well on site - ( y / n ) ft, <br /> If yes, location and distance - //JJ ��/ ft. <br /> = c <br /> SAMPLING slot ed <br /> sacPen Holding Temperature = yTavdPadt <br /> Method <br /> Screening Method �3 .C12 _ <br /> Tracking Sheet y n ) k• o <br /> wAl ft. = ft. <br /> SPOILS T) _� N <br /> Storage Method t MATERIALS/DEVELOPMENT <br /> Contamination Noted - n ) — tib r( <br /> Storage Location Dwl t: Casing type �Z/ <br /> �Z _ Pik Blank ft. Screen <br /> Y slot size . D? U <br /> GROUTING Bags cement l <br /> Buckets.,kentonite <br /> Depth to water Bag ssa gravel_ <br /> Mix Ratios Filter tck 4e size tA <br /> Installation Method g] Surge Block: - ( y / <br /> Quantity Installed Discussed with geologis,(f n ) <br /> Type of method <br /> EH 29 29 <br /> li <br /> I; <br />