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MONITORING WELL INSTALLATION REPORT <br /> Date: L-7d CONSTRUCTION <br /> Premise Address:_ Total Depth �1 q <br /> Screen Length (from) (to) <br /> Well No.: m w— Filter Pack (from)_Qj Z (to) <br /> Bentonite (from) ' -Cl� (to) <br /> Inspector: �A�cr–,I Grout (from) (to) <br /> Z I Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion- Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller:_ Ta A, „ casing <br /> height <br /> Consultant eesL-- I <br /> Geologist ._ <br /> AWVE-GROUND <br /> COMPLETION CHSZ1 Y-80X <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Sumacs <br /> Distance to sewer 1' grout <br /> Domesric well site - (y/ n ) <br /> If yes, loc n and distance - ft. <br /> . _ft. Z ft. <br /> — a <br /> SAMPLING = <br /> Clotted c <br /> section — <br /> Holding Temperature r•s�. t c;� <br /> Method_- (�'`(T,,,.,� pow _ gnvelPack <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> SPOILS <br /> Storage Method_ s 5�Ckt�.� Q�A MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y n ) <br /> Storage Location Casing type 2 PV <br /> Blank ,�'- ft. Screen ft. <br /> Slot size OLO <br /> GROUTING Bags cement <br /> Buckets bentonite Z <br /> Depth to water ti Bags sand/gravel ^-/& <br /> Mix Ratios L4 L Filter Pack type/size 2 12 <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />