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MONITORING WELL INSTALLATION REPORT <br /> Date: l.Z I '�'d �- CONSTRUCTION <br /> Premise Address:__ 'J3600 _ Total Depth l t b <br /> Screen Length (from) (cc (to) f(zy <br /> Well No.: V1�W-1. Filter Pack (from) q-4- <br /> Bentonite (from) a �( (to) # Sa <br /> Inspector: _ (l t�� %<< Grout (from) 54 (to) Tj <br /> Drilling rig type <br /> Permit No. JAZ �S ) Auger O.D. I.D. <br /> Drilling Company: <br /> Completion- Stove pipe/christie box (circle one) <br /> (� <br /> Driller:_ 5e2 casing <br /> height <br /> Consultant n ` '�C�' c--C &A-� <br /> Geologist kv )kt4� <br /> ABOVE-GROUND <br /> COMPLETION CFiMM-BOX <br /> SPECIAL PERMIT INFO. Grcxjnd SL;rfycs <br /> COMPLETION <br /> Distance to sewer line grout <br /> Domestic well on site - / n ) <br /> If yes, location an istance - ft. <br /> too ft. ft <br /> = m <br /> p <br /> SAMPLING slotted — c <br /> &action = <br /> Holding Temperature ova ► e- <br /> _ <br /> Method gravel Pacts <br /> Screening Method = <br /> Tracking Sheet - (y/ n) — <br /> _.1. d ft. <br /> SPOILS p l <br /> Storage Method C5 cxt�C dew• _MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location H,v,S w Casing type_ 2 ('V Z <br /> Blank Loo ft. Screen id ft. <br /> Slot size_ . o?& <br /> GROUTING Bags cement <br /> Depth to water -� S r Buckets bentonite Z <br /> Bags sand/gravel_ ^j <br /> Mix Ratios 5 S w� Filter Pack type/size -z ( t-2-- <br /> Installation Method '` ._;( Surge Block: - (y/ n ) <br /> Quantity Installed c, Discussed with geologist: - (y/ n ) <br /> EH 29 29 Type of method <br /> to 0 <br />