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MONITORING WELL INSTALLATION REPORT <br /> Date: t O 1211 I0`7- / CONSTRUCTION <br /> Premise Address:_3 7B'• W C 1\o.AA , I �ANm `Total Depth S <br /> hti�-2d JScreen Length (from) 1.w� (to) � <br /> Well No.: Filter Pack (from) L n '' (to) ,Y te=a <br /> Bentonite (from) 65.5 (to) <br /> Inspector: �knaAr Grout (from) d (to) 6R-5' <br /> Drilling rig type <br /> Permit No. D b Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: kAj�k O <br /> Driller: 50 "Acasing <br /> Consultant C(L Ar <br /> T height <br /> Geologist <br /> ABOVEGROUND CNA STY80X <br /> COA4'LETION COMPLETION <br /> SPECIAL PERMIT INFO. Ormond Surface <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n (q,5-- <br /> If <br /> If yes, location and dista n' <br /> 0 <br /> C <br /> SAMPLING abtted = c <br /> section <br /> Holding TemperatureP <br /> Method L "s��e <br /> Screening Method I — <br /> Tracking Sheet • (y/n <br /> SPOILS <br /> Storage Method (AAAAal.: • MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y <br /> Storage Location 6In4, (., Casing type 2 "PVC <br /> Blank '43.5 ft. Screen p ft. <br /> Slot size OzO <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel N <br /> Mix Ratios Filter Pack type/size B IZ iwwc <br /> Installation Method z n. / d 1^ lu Surge Block: - ( y/CrO <br /> Quantity Installed —T Discussed with geologist: - ( y/0 <br /> Type of method <br /> EH 29 29 <br />