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MONITORING WELL INSTALLATION REPORT <br /> Date: I D It Z b I 0 --�' CONSTRUCTION <br /> I <br /> Premise Address: ul `IO ('/J.. ,,,,,.4--c. W-,, Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: rc'i Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: <br /> Completion - Stove pipe/christie box (circle one) <br /> W)� (' <br /> Driller: Soy u, casing <br /> height <br /> Consultant GV7-A —qw, <br /> Geologist 1"n'AY�Lt r' <br /> ABOVE-GROUND <br /> COMPLETION C4-(P9M-BOX <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 distan - n' <br /> ft. <br /> ft. <br /> = m <br /> N <br /> 0 <br /> C <br /> SAMPLING = ° <br /> �btted — c <br /> section <br /> Holding Temperature Wit', <br /> Method <br /> vel <br /> Screening Method !L� <br /> Tracking Sheet - (y/ n ) <br /> a; <br /> SPOILS <br /> Storage Method bt" MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) l ,i <br /> Storage Location Casing type 1 JOYCi <br /> Blank }-C) ft. Screen-------LD ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water IV W, Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br /> 0 <br />