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400NITORING WELL INSTALLATION REPORT <br /> Date: I Z 18b CONSTRUCTION <br /> 1 <br /> Premise Address: LtCAA Total Depth <br /> Screen Length (from) 1 b �_(to) O <br /> Well No.: lJ -Z Filter Pack (from)— _(to) 4T_ <br /> Bentonite (from) S (to) <br /> Inspector- A,^-,n _ Grout (from) � (to) 5 <br /> Drilling rig type <br /> Permit No. Auger O.D. <br /> Completion - Stove pip uistie b t (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant �GCOtZVl <br /> -Q <br /> Geologist O nn.� - T <br /> —l� ABOVEliAL`UND CHRLM-BOX <br /> COMPLETION ccmPLET1cN <br /> SPECIAL PERMIT INFO. Ground Sirtaca <br /> Distance to sewer line Grout <br /> Domestic well on site - (y/ n) <br /> If yes, location and distance - ft. <br /> — a <br /> _ — o <br /> SAMPLING slorai <br /> sedcn <br /> Holding Temperature 616 N as <br /> Method 4pA <br /> Screening h�T� l7, <br /> r " Y <br /> Tracking Sheet - C.9nAi.) ;: <br /> D ft. — tr <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) 1. <br /> Storage Location Casing type <br /> Slam[ `C2 ft. Screen —ft. <br /> Slot size n-20 <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water 2`6 Bags sand/gravel S' <br /> Mix Ratios Filter Pack type/size 3 <br /> Installation ethos Surge Block: - �y / n ) <br /> Quantity installed r, 2 Discussed with geologist: - (y/ n) <br /> Type of method <br /> EH 29 29 <br />