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MONITORING WELL INSTALLATION REPORT <br /> Date: 1 I 3I L) I� CONSTRUCTION <br /> // - �m4vLic ;V�,� <br /> Premise Address:_ / 6 � E - �i �{ _v�' Total Depth aU 1(7.,T- /a.o` <br /> Well No.: <br /> I/��- ( � �a,d dScreen Length (from)' ( 0, (to) X07-' <br /> ✓SSI+w�"- FIlteiPack (from) 100 (to) Ila, <br /> Sid 48=Iod Bentonite' (from) 93 (to)�_ <br /> Inspector: Grout (from) (to) <br /> Drilling rig type AlUbt Vcfc&rc^ <br /> Permit No. Auger O.D. 0 I.D. <br /> Completion- Stove pipe/chrnstie box (circle one) <br /> Drilling Comp any: �L l l�- ' <br /> Driller: NVL(1 �� casing <br /> ' / height <br /> Consultand_ IN <br /> Geologist <br /> ABOVE-GROUND <br /> C01.'PLE-r10N CNAISTY-8aX <br /> SPECIAL PERMIT INFO. Ground Sw1xs COMPLETION <br /> Distance to sewer line Grp <br /> Domestic well on site - (y/n) G,3 <br /> If yes, location and distance - (UG <br /> 0 ft. <br /> Y� — m <br /> _ 30 <br /> SAMPLING _ ' S <br /> slotted = E <br /> &action <br /> Holding Temperature <br /> Method ` = 9""64 Pa <br /> Screening Method <br /> Tracking Sheet - (y/n) — <br /> 0 7 ft. Sg- <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted- (y/n) <br /> Storage Location Casingtype SVC- 06 PUS- ( / <br /> Blank 1t0 ft Screen 5^ ft. <br /> Slot size o f O)-O <br /> GROUTING Bags cement <br /> Buckets bentonite 3 , <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size_ No , 3 <br /> Installation Method <br /> Quantity Install ed Discussed with'geologist: - Cy/ n) <br /> EH 29 29 Type of method <br /> 0 <br />