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MONITORING WELL INSTALLATION REPORT <br /> Date: 3(Z\l O� CONSTRUCTION <br /> Premise Address:_ Z%Z-L ,� Total Depth <br /> Screen Length (from) (to)__ <br /> Well No.: K&LkJ - 1 Filter Pack (from) (to)__ <br /> Bentonite (from) (to) <br /> Inspector: _ ��t,, c�, Grout (from) (to) <br /> Drilling rig type <br /> Permit No. S 3 Auger O.D. I.D. <br /> Drilling Company:_ <br /> Completion - Stove pipe/christie box (circle one) <br /> IM��,-a�,-�.1� <br /> Driller:_ casing <br /> height <br /> Consultant_ <br /> .� <br /> A80 -GFOUND CNAISTY 80X <br /> COA�PLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surlace <br /> Distance to sewer line grout <br /> Domestic well on si - (y/ n ) <br /> If yes, location distance - ft• <br /> ft. <br /> ft. <br /> = m <br /> q <br /> = C <br /> SAMPLING = ° <br /> tlottad � <br /> vection '-" � <br /> Holding Temperature_ vti — <br /> Methodrb "4,.sM slp — V"'a1 pack <br /> Screening Method_ Pi 1) — <br /> Tracking Sheet - n ) — <br /> {� <br /> SPOILS <br /> Storage Method 6-5 MATERIALS/DEVELOPMENT <br /> Contamination Noted - n ) <br /> Storage Location Cp�S4�. Casing type Zi CVS <br /> Blank______l oo ft. Screen <br /> Slot size -0 2 d <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/sizez/rz- <br /> Installation Method Surge Block: - ( y/ n ) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />