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0 <br />MONITORING WELL INSTALLATION REPOn <br />Date: '!L 2, 2 <br />Premise Address: P1.0 S ��► �r";i°"� <br />Well No. <br />Inspector: <br />Permit No. -5 <br />Drilling Company: ;16=9��� <br />Driller: To� 1 <br />2-1 <br />Consultant 0 7-1 t, <br />Geologist 24 Pte - <br />SPECIAL PERMIT INFO. <br />Distance to sewer line t&0 <br />Domestic well on site - ( y 4V <br />If yes, location and distance - <br />SAMPLING / <br />Holding Temperature <br />Method <br />Screening Method <br />Tracking Sheet - <br />SPOILS <br />( y / n ) <br />Storage Method <br />Contamination Noted -( y n <br />Storage Location ( ?_� <br />GROUTING <br />Depth to water <br />Mix Ratios <br />Installation Method <br />Quantity Installed <br />EH 29 29 <br />3-22,, ,-,e 16 14w-/ <br />CONSTRUCTION <br />Total Depth :55 <br />Screen Length (from) (to) Z <br />Filter Pack (from) 6 (to) 7, <br />Bentonite (from)____?— (to) 7-c� <br />Grout (from) (to) <br />Drilling rig type r-tAS "? S <br />Auger O.D. 10 I.D. �o <br />Completion - Stove pipe/christie box (circle one) <br />casing <br />height <br />ABOVE -GROUND <br />COMPLETION <br />grout <br />ZO ft. <br />MATERIALS/DEVELOPMENT <br />►� <br />Casing type <br />Blank ft. .4 Screen -C) R• <br />Slot size_ o 20 <br />f. ags cement i <br />Buckets bentonite OV <br />Bags sand/gravel - <br />Filter Pack type/size — <br />Surge Block: - (y n jjj <br />Discussed with geologist: - ( y n ) <br />Type of method <br />