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MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address: Z , Q ��t iJV v��u Total Depth <br /> Well No.: Z Screen Length (from)_ 45 (to) i <br /> Filter Pack (from) N(o (to) <br /> Bentonite (from) -L4 (to) <br /> Inspector: �n (L�L1/lIM Grout rig <br /> 2,n (to)- — <br /> ��� G� Drilling S t5'P e GTrZ�LL1� <br /> Permit No. . �1 O Auger O.D. <br /> Completion- Stove pipe/ stie (circle one) <br /> Drilling Company: 11/ <br /> Drilled: casing <br /> v � � height " <br /> Consultant mil- t, - <br /> Geologist J&\ <br /> A OVE-GROUND <br /> CD 1,3i'LET{O N C7-lA ISTY-80 X <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n) <br /> If yes, location and distance - <br /> 255 <br /> SAMPLING .bttad — <br /> • s-aeon - _ � <br /> Holding Temperature <br /> Method g­4P� <br /> :3 <br /> Screening Method <br /> Tracking Sheet - (y/n) <br /> 1413 tt. _ 141r' tt. <br /> SPOILS <br /> Storage Method MPTERLALS/DEVELOPMENT <br /> Contamination Noted - (y/n) <br /> Storage Location Casing type 2," i VC <br /> Blank 2 ft. Screen ZQ ft. <br /> Slot size D <br /> GRO=G Bags cement <br /> Buckets bentonite' <br /> Depth to water Bags sand/gravel —9 <br /> Mix Ratios Filter Pack type/size !rand <br /> Installation Method Surge_Block:�-_Oy <br /> Quantity Installed Discussed with geologist: - n ) <br /> Type of method <br /> EH 29 29 <br />