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MONITORING WELL INSTALLATION REPORT <br /> Date: 3 3 D CONSTRUCTION <br /> Premise Address: G Z r.al.�nn„�C� Total Depth }O <br /> Screen Length (from)_ !6c -(to)--7-0 <br /> Well No.: W\ IV �J c� M W 1 C7 Filter Pack (from) �" , <br /> Bentonite (from) 5-' 5- (to) s K <br /> Inspector: Grout (from)__ <br /> Drilling rig type <br /> Permit No. Auger O.D. I.L . <br /> Completion - Stove pipe/christi? box (circle one) <br /> Drilling Company: �_�-cif,.. <br /> Driller: 4 �^ casing <br /> height <br /> Consultant �C�� + <br /> Geologist1�u •� <br /> ABOVE-GROUND <br /> ox <br /> OOWLETION COMPLETION <br /> C}fPLE- oN <br /> SPECIAL PERMIT INFO. Ground Surface • <br /> rn— <br /> Distance to sewer line IcOut <br /> Domestic well �- nIf yes, location S <br /> fft. <br /> t. <br /> O <br /> SAMPLING dotted `- <br /> iPG�On :a•': <br /> Holding Temperature Cw g , P <br /> ack <br /> Method (." ly.ow, i(aa.v .. <br /> Screening Method P t N� — <br /> Tracking Sheet - 'y^ n ) —" <br /> 1-0 ft. — ft. <br /> SPOILS <br /> Storage Method 5$ 15 o�vt�. MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y�) <br /> Storage Location cn.y-r✓, Casing type L " F!}L_ <br /> Blank 6o ft. Screen R) h• <br /> Slot size v41®iy 6C(o <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel 3 <br /> Mix Ratios Filter Pack type/size—:;Lr,3 <br /> Installation Method Surge Block: - / n ) <br /> Quantity Installed —T Discussed withg6ologist: - 0/ n ) <br /> Type of method <br /> EH 29 29 <br />