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MONITORING WELL INSTALLATION REPORT <br /> Date: c � l CONSTRUCTION <br /> Premise Address:tx;�l`�r .., � >,�i,( , .►.ac�t.'-Total Depth 1 U T'i �`� <br /> Screen Length (from). V (to) <br /> Well No.:_Y'Yl (�� Filter Pack (from) C (to) <br /> `I Bentonite (from) (to) . <br /> Inspector:-S, l c�c'���- ��, - <br /> Grout (from) (to) <br /> Drilling rig type`" �� `_= ti-�\c_ <br /> Permit No. Auger O.D. I.D. <br /> Drilling CompanyCompletion - Stove pipe/christie box (circle one) <br /> �G,�-'�p � l �J� � <br /> Driller:_ casing <br /> Consultantheightt�� � <br /> Geolo st <br /> � ��► � ,'ice � �� -_ <br /> JlBrJ1/E-G A OUND <br /> ccwLET{ON C -LR STY-BGX <br /> SPECIAL PERMIT INFO COMPLETION <br /> Ground Surfacs <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n) �. <br /> If yes, location and distance - <br /> SAMPLING = o <br /> s!o ttsd .' — c <br /> Holding Temperature = <br /> Method _= grzval Pack <br /> Screening Method —' <br /> Tracking Sheet - (y/n) _ <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y n <br /> Storage Locator -F_ C,, ,��T � i.c Casing type�j a <br /> "A �� ���cz1C-� Blank '&1_9 ft. Screen L_� ft. <br /> GROUTING Slot size O CAiC <br /> Bags cement t_5 <br /> Buckets bentonite <br /> Depth to water ,` Bags sand/gravel <br /> Mix Ratios ��rs �� .� aFilter Pack type/size <br /> Installation Method_ v sw+�w�� -__Surge Block._=�� <br /> Quantity Installed Discussed with geologist: _03 n ) <br /> EH 29 29 Type of method <br />