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MONITORING WELL INSTALLATION REPORT <br /> Date:_ S ' Z CONSTRUCTION <br /> Premise Address:�(�Z , ��I�,!OyN.�4 �� . Total Depth -70 F- <br /> Screen Length (from) 7 U (to) <br /> Well No.:_�V1/� Filter Pack (from)_ -70 <br /> Bentonite' (from) Sg (to) <br /> Inspector: J n�,11�y y d d�IL LAS Grout (from) (to) <br /> I _Q�O�� Drilling rig type G1�t1 --W— <br /> Permit No. � ((1 J Auger O.D. <br /> Completion- Stove pipe Christie box (circle one) <br /> Drilling Company:__I r_���I . <br /> Driller:TlA.rilLA casing <br /> ,n T height <br /> Consultant,, n <br /> Geologist V y \a'Cr ( �I�(� <br /> ABOVE-GR OUND <br /> COIPLETION CHRZ7Y-BOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surfs" <br /> Distance to sewer line D� <br /> Domestic well on site - (y/n) tt. <br /> If yes, location and distance - <br /> SAMPLING = — <br /> tt*clon — <br /> Holding Temperature = P <br /> ack <br /> Method <br /> Screening Method <br /> Tracking Sheet (y/n) -- - <br /> _�0 tt. _ `70 <br /> SPOILS <br /> Storage Method M?,TERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) <br /> Storage Location Casing type 2-,y Gc k VC <br /> Blank O (00 ft. Screen (o D i 70 ft. <br /> Slot siz o .OZO <br /> GROUTING Bags cement <br /> Buckets bentonite' l�uG <br /> Depth to water Bags sand/gravel V :9 of 544'l <br /> Mix Ratios Filter Pack type/size#3 .41 <br /> Installation Method_ _____Surge_Block: - /_n_) <br /> Quantity Installed Discussed with geologist: - (y/ n) <br /> Type of method <br /> EH 29 29 <br />