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MONITORING WELL INSTALLATION REPORT <br /> 3 _y CONSTRUC i I ON <br /> Date: � <br /> /3�7 %�� � f �l Tonal Depth <br /> Premise Address: 3` '`` P <br /> v'__ Screen Length (gym) i4 a-_ (to) r� <br /> Filter Pack (from) L/},S� (to) <br /> Well No.: I/ Bentonite (from) Wit? (to) /7 <br /> Grout (from) I7 (to) <br /> Inspector. C G' Drilling rig type // ' -- <br /> Auger O.D. /0 " I.D. <br /> Permit No. <br /> Completion- Stove pipe/christie box (circle one) <br /> Drilling Company <br /> casing <br /> Dn11er. height <br /> i <br /> Consultant P � "�-'' �''�''`�� • <br /> Ce <br /> Ge�6�i-z ( , �771D <br /> Y—c-GROUND <br /> C,"IvPL�i]ON C�riP:�=ilCP2 <br /> Gcaur,C Sur!r_s , <br /> SPECIAL P£RNII T INFO. <br /> procrt <br /> Distance to sewer line <br /> Domestic well on site - (y/ n) fL <br /> If yes, location and distance - A, <br /> - = z <br /> 72 <br /> //�)) <br /> SAMPLING a <br /> `� C fJOLiYd _ a <br /> `•" <br /> sec.-On _ — <br /> .r 7XV14 Pack <br /> Holding Temperature -= <br /> w — <br /> Method <br /> Screening Method - _— <br /> Tracking Sheet - (y/ n) IL = r L <br /> SPOILS <br /> DD ��� MA'i'F.RIALS/DEVELOPMENT <br /> Storage Method /l <br /> Contamination Noted - (y/V Casing type L <br /> Storage Location Blank a1 ft- Screen fT- <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite a <br /> c�r�r)(I P,�K��� _ Bags saad/gsavel <br /> Depth to water f� Filter Pack typesize <br /> Mix Ratios_ ° <br /> Surge Block: - C Y/ <br /> Installation Method Discussed with geologist: - C Y/ n ) <br /> Quantity Installed Type of method <br /> EH 29 29 <br />