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MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> ' JoA M'o <br /> Premise Address: l(0Du Total Depth <br /> Screen Length (from) (to) 4t1 I I,D <br /> Well No.: Filter Pack (from) nti (to) 5Q "L <br /> Bentonite (from) (to) ' <br /> Inspector: Grout (from) (to) <br /> Drilling rig type INCtL <br /> Permit No. Auger O.D. (6 I.D. <br /> Drilling Company: <br /> \ �� Completion - Stove pipe/)!!Ts (circle on ) <br /> W tie b <br /> Driller: 9)u o casing <br /> height <br /> Consultant h6o t o►A 11F <br /> TTE <br /> Geologist <br /> ABOVE-GROUND <br /> COMPLETION c4�R* Y-BCX <br /> COMP -TICN <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line Gfout <br /> Domestic well on site - ( y/ n ) ft. / ;� <br /> If yes, location and distance - ft.14rj.- <br /> 0 <br /> SAMPLING <br /> slotted <br /> V sacson <br /> Holding Temperature <br /> gravel pa& <br /> Method j, - <br /> Screening Method - 1 tv►�-� 21C <br /> Tracking Sheet n ) ear., 9� <br /> SPOILS <br /> Storage Method C01VR�lf�r�/1'{�� � �� MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) <br /> Storage Location tJSIyt, Casing type <br /> Blank ' ft. Screen ft. <br /> Slot size D a-lAit <br /> GROUTING Bags cement <br /> I Buckets bD�tonite�' %A Aci -7,MWV7751A <br /> Depth to water V� Bags��ndj'gravel(A IhVA.S 1 <br /> Mix Ratios Filter ck type/ e "1 <br /> Installation Method Surge Block: - / n ) <br /> Quantity Installed Discussed with eolo st: - (�/ n } <br /> Type of method rf i�tA1AP <br /> EH 29 29 <br />