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MONITORING WELL INSTALLATION REPORT <br /> 3 - 9fl CONSTRUCTION <br /> Date: <br /> ' Depth �_�5 <br /> Premise Address: 3 Y 3 7 A�•r�u-f �'`� — Total Screen Length (from) L r S� (to) 55 5 <br /> Filter Pack <br /> Well No.: C �' ' z - Bentonite (from) <br /> Grout (from) <br /> Inspector. l' • �T Drilling rig type /v�✓ SdF�r' <br /> Auger O.D. <br /> Permit No. / S-7 Completion - Stove pipe/christie box (circle one) <br /> Drilling Company, <br /> casing <br /> Driller- " - �'� `"'"'E 7 height <br /> If <br /> D "T <br /> Consultant T <br /> OOkgL_ErCN C_-Up!_�CN <br /> Ground Sumacs <br /> SPECIAL PERMIT INFO. grout <br /> Distance to sewer line I ft. <br /> Domestic well on site - (y/ n ) tL <br /> If yes, location and distance - <br /> .►— <br /> 0 <br /> dotted <br /> SAMPLING asc+on _ <br /> 7xv9I pack <br /> Holding Temperate <br /> Method ' <br /> Screening Method - __ <br /> Tracking Sheet - (y/� = �► tt- <br /> �._IL <br /> SPOILS p _ <br /> J D - 5- MATE RIALS/DEVELOPNENT <br /> Storage Method <br /> Contamination Noted - (y/ casing type �.�' `� r, <br /> Storage Location e"/�'" �- Bl� �S ft Screen Cl <br /> Slot size <br /> Bags cement <br /> GROUTING Buckets bentonite ��� <br /> Bags sand/gravel a /� <br /> Depth to water a�rG F- �_74 � ,e Filter Pack type/size <br /> Mix Ratios " Surge Block. - Cey n) <br /> Installation Method Discussed with geologist - C y/- <br /> Quantity Installed >z 6- <br /> Type of method <br /> EH 29 29 <br />