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tTiONITORING WELL INSTALLATION REPORRf <br /> Date: '6 I22 �C) U II CONSTRUCTION <br /> Premise Address: 16 Total Depth 3b <br /> Screen Length (from) (to) 30 <br /> Well No.:. S V L—J. Filter Pack (from)_ _(to) 30 <br /> Bentonite (from) -Z-- (to) ; <br /> Inspector. Grout (from) -A (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> ^ ' Completion - Stove pip clui e x (circle one) <br /> Drilling Company: l���Yl/�/` <br /> Driller: ? VIA _ — casing <br /> ��jheight <br /> Consultant S LZ 0 2 T <br /> Geologist V e - T <br /> ABCVE-GACUND C4-S7 Y-aCX <br /> COU31-E CN CCMPLEnCN <br /> SPECIAL PERMIT INFO. Ground S macs <br /> Distance to sewer line RD <br /> grout <br /> Domestic well on site - ( y/ n ) Z ft. <br /> If yes, location and distance - ft <br /> s tt. <br /> — - o <br /> = o <br /> — o <br /> SAMPLING dorsi <br /> a cn —_ <br /> Holding Temperature S. gn",yxk <br /> Method A _ <br /> Screenin;Method I n <br /> Tracking Shcet - n ) <br /> 3o <br /> SPOILS <br /> Storage Method crIN !C(°NA-c MATERIALS/DEVEI.OPMENT <br /> Contamination Noted - ( n ) <br /> Storage Location <br /> 01AS F{ Casing type 0 <br /> Blank_______5'- ft. Screen el ft. <br /> Slot size r 0'1- <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water ^.) Z Bags sand/gravel <br /> Mix Ratios Filter Pack type/size 3 /� <br /> Installation Metho Surge Block: - ( y 11 <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />