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MONITORING WELL INSTALLATION REPORT <br /> Date: rr 'Iq CONSTRUCTION / 0� <br /> Premise Address: Total Depth b <br /> Screen Length (from) (to) 6 <br /> Well No.: Filter Pack (from) (to) <br /> CJ Bentonite' (from) (to)y�-7 <br /> Inspector: h 84 Grout (from) <br /> Drilling rig type 'L <br /> Permit No. Auger O.D. 1 I. <br /> �1 et I 1� Completion - Stove pip c istie b (circle one) <br /> Drilling Company: ` t l��f�1 <br /> Driller:_ Jot. �� casing <br /> height <br /> Consultant � ` <br /> Geologist 'G) 1� l 1.'NI(wVIN ._ <br /> ABOVE-GROUND <br /> CO WF LETIO N CNA ISiY 80X <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line grout <br /> Domestic well on site - (y/Gft. <br /> If yes, location and distance - <br /> ft. <br /> ft. <br /> `•ice. � O . <br /> SAMPLING �p�Q� �-,d'• �e�•}' -°� = c <br /> Co tied <br /> Holding Temperature = <br /> Method ! <br /> S I i bZ� — <br /> Screening Method <br /> Tracking Sheet (y/n) -- _ <br /> SPOILS SO 11 I f1 <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y(/n <br /> Storage Location S 1 Casing type ' q,0 PUG <br /> Blank s_9 ft. Screen /j:�) ft. <br /> Slot size O C� <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel_ <br /> Mix Ratios q .a Filter Pack type/size <br /> Installation Method � <br /> Quantity Installed_ i�r�-,� Discussed with geologist: -&Vn ) <br /> EH 29 29 Type of method <br /> L <br />