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MONITORING WELL INSTALLATION REPORT <br /> Date: 'y' Z2- <br /> CONSTRUCTION <br /> Premise Address: /G 211 YJ 4p," Total Depth U / <br /> �ScreenLength (fromj' IOS (to) <br /> Well No.: K�-1 {✓�wslf <br /> Filter Pack (from) 7 (to) <br /> Inspector: �- Y04'ti[ 7SBentonite*95(from)�(to) c ,� <br /> ltO.as-iia' Grout (from) (to) <br /> Drilling rig type ��,� o <br /> Permit No. SR47G91y2 AugerO.D, IN I.D. <br /> P y /U� DQ I4.CUU� Completion- Stove pipe/christie box (circle one: <br /> Drilling Com an :_ <br /> Driller: c as ing <br /> Consultant 'e�3au G'NUlQy height � <br /> Geologist A* _ <br /> ABOVE-GFCUND <br /> COMPLETION CliA1STY�OX <br /> SPECIAL PERMIT INFO COMPLETION <br /> C3round Swixa <br /> Distance to sewer line Qrart <br /> Domestic well on site - (y/n) q s ft. <br /> If yes, location and distance - <br /> [�a;7Sg 06,a tt. <br /> m <br /> SAMPLING = o <br /> Zia — 'c <br /> sac�on <br /> Holding Temperature <br /> Method = grxvsl pack <br /> Screening Method <br /> Tracking Sheet - (y/n) _ <br /> �l IS <br /> tt. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) <br /> Storage Location Casing type SCL� q40 PO L <br /> Blank a ft. Screen <br /> GROUTING Slot size 0 , O at <br /> Bags cement <br /> Buckets bentonite 3, <br /> Depth to <br /> Mix Ratios water Bags sand/gravel <br /> Installation Method_ Filter Pack type/size /,J o, 3 <br /> QuanttyInstalled Discussed witheolo st: - <br /> g Si CV/ n) <br /> EH 29 29 Type of method <br />