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MONITORING WELL INSTALLATION REPORT <br /> Date: ( 00 CONSTRUC'T'ION <br /> Premise Address:_:'_ Lgnj (rit _ Total Depth 6 i <br /> Screen Length (from) ` (to)____ <br /> Well No.: DA j 4) Filter Pack (from) L (to) 7K/ <br /> Bentonite (from) z (to) <br /> Inspector: _ s oma_ Grout (from) (to) I <br /> Drilling rig type <br /> Permit No. Auger O.D. 1 c-y k° _ I.D. <br /> Completion - Stove pipe/cl3ristie box (circle ane) <br /> Drilling Company:,�W 924-1.I <br /> Driller: S �6i_ casing <br /> —f t height <br /> Consultant ''-e– 5ho,4iA2 <br /> T <br /> Geologist -- T <br /> A 0VE-GRMN0 CHRM 1Y-a0X <br /> COWPL TICN CO PL_MN <br /> SPECIAL PERMIT INFO. Grourd Suslact <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - <br /> .,�.tt. <br /> J+• N <br /> SAMPLING <br /> socicn <br /> Holding Temperature inn [ pavaf�ctc <br /> Method <br /> Screenin; Method e U <br /> Tracking Sheet - +/ n ) <br /> n. a rt. <br /> SPOILS <br /> Storage Method S' MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ ,f D11 p�� <br /> Storage Location Casing type <br /> Blank ft. Screen z ft. <br /> Slot size , 0 TO <br /> GROUTING Bags cement <br /> Buckets bentonite�� <br /> Depth to water— .^I t t t Bags sand/gravel <br /> Mix Rarios Filter Pack type/size a I� <br /> Installation Method _ Surge Block: - (y/ <br /> Quantity Installed Discussed with geologist: - (y/0 <br /> Type of method <br /> EH 29 29 <br />