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MONITORING WELL INSTALLATION REPORT <br /> Date: /�_ 3 D `l ry CONSTRUCTION <br /> Premise Address: 3 7t4 Total Depth /") <br /> Screen Length (from) 7 rY' (to) Ste' <br /> Well No.: C�� ��x � Filter Pack (from) -71- _(t0)__s__10' ' <br /> Bentonite (from) s[, ' (to) � S� ' <br /> Inspector: Z- _ Grout (from) s V ' (to) -jam= <br /> Drilling rig type /7 od_'eck') s1Y <br /> Permit No. Auger O.D. 'L7 __ I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant /�a-+ s» i_5 <br /> 7M1,7//, T <br /> Geologist ��'' - --aha1 Ai;VF GACl1ND <br /> COMPIETfON CNAtSTY-80X <br /> COMPLEnCN <br /> SPECIAL PERMIT INFO. Ground Sudws <br /> prcut <br /> Distance to sewer line <br /> Domestic well on site - (y/ n ) ft. <br /> If yes, location and distance - ft. <br /> —ft. <br /> SAMPLING ,. well _ <br /> " (J sccicn � <br /> Holding Temperature fu roi� = gavdc <br /> Method <br /> Screenin;Method — <br /> Tracking Sheet - (4y n ) ; <br /> ft. <br /> SPOILS <br /> Storage Method G'N MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/(b <br /> Storage Location v. 1„ �l� Casing type t/ <br /> Blank ft. Screen v ft• <br /> Slot size U <br /> GROUTING Bags cement <br /> Buckets bentonite � - <br /> Depth to water �l5 Bags sand/gravel_ -� <br /> Mix Ratios S CIO i�^ T nem z�-� Filter Pack type/size ' <br /> Installation Method- 4r-r- k, Surge Block: - (CV n ) <br /> Quantity Installed Discussed with geologist: - (T/ n ) -�. <br /> Type of method -TIA cX 4z� <br /> EH 2929 <br />