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MONITORING WELL INSTALLATION REPORT <br /> Date: Ll l'L I to CONSTRUCTION <br /> Premise Address: 1 oTotal Depth (�Q <br /> 1 Screen Length (from) 'I e> <br /> Well No.: C� Filter Pack (from) �_(to)_�Z� <br /> Bentonite (from) (to)_Inspector: +— Grout (from)_ <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: <br /> Completion - Stove pipe/christit- box (circle one) <br /> �.� ,�,r. <br /> Driller: <br /> casing <br /> Consultantheight <br /> _. �h P-7L <br /> Geologist ` _« <br /> ABOVE-GROUND <br /> COMPLETION C Intm-8oX <br /> SPECIAL PERMIT INFO. COMPLETION <br /> Ground Surfacs <br /> Distance to sewer line troy t <br /> Domestic well on site - ( i ) <br /> If yes, location and ce - <br /> _ b <br /> = m <br /> SAMPLING o <br /> slotted _ B <br /> section <br /> Holding Temperature C4. ca <br /> Method G" �n.�,�v, 5 73�w Pack <br /> Screening Method 1 D <br /> Tracking Sheet y n) =` _ <br /> SPOILS <br /> Storage Method G uh MATERIALS/DEVELOPMENT — <br /> Contamination Noted - (y/ n <br /> Storage Location I-'"A-6-t` Casing type <br /> Blank LL O ft. Screen !2 ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: -(Cy)/ n ) <br /> Quantity Installed Discussed with geologist: - (y �n�l <br /> Type of method <br /> EH 29 29 <br />