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MONITORING WELL INSTALLATION REPORT <br /> Date:__ CONSTRUCTION <br /> Premise Address: f9O a- ( P q Total Depth / <br /> Screen Length (from) (to) <br /> Well No.:_ – �� Filter Pack (from) (to)-�/�— <br /> Bentonite' (from) c (to) <br /> Inspector: TU�,�/►y Grout (from) . S (to)_ <br /> Drilling rig type CA G- <br /> Permit No. Auger O.D. Sz ZK– I. It, <br /> n I( _ �� Completion- Stove pipe stie ox (circle one) <br /> Drilling Company: tC t <br /> Driller:_ �`� J{�!� casing <br /> height <br /> Consultant <br /> Geologist I` G h All(Mui-) Aid ._ <br /> -,Q v4'�`' .ABOVE-GROCMD <br /> CO h3P LETIa N CNA CGMPLETiCN 1STY-80X • <br /> SPECIAL PERMIT INFO. end Surf acs <br /> Distance to sewer line grout <br /> Domestic well on site - (y n ( <br /> If yes, location and distance <br /> ft, ft. <br /> A:• p <br /> SAMPLING n0 5un�pl _ o <br /> _ slotted •:_: c <br /> • aac�on = � , <br /> Holding Temperature — <br /> Method _ = gnvo pack <br /> Screening Method <br /> Tracking Sheet (y/n) <br /> SPOILS <br /> Storage Method_ S'011 MATERIALS/DEVELOPMENT <br /> Contamination Noted -Oy�,Y n) <br /> Storage Location_ D`l s t Casing type qd rj)(/, <br /> Blank 25 ft. Screen :20 ft. <br /> Slot size 10)_0 <br /> GROUTING Bags cement <br /> Buckets beiztonite _ <br /> Depth to water OBagsan gravel <br /> Mix Ratios CNN <br /> alh Filter ack type/ ' ei <br /> Installation Method u ______. Surge.Block===� 11-) <br /> Quantity Installed Discussed with geologist: - (y/n) <br /> EH 29 29 Type of method_ v5 <br />