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MONITORING WELL INSTALLATION REPORT <br /> Date: 5� _Z Y6)0 2 CONSTRUCTION <br /> Premise Address: �)� Total. Depth <br /> Screen Length (from) (to) <br /> Well No.: JM (w) — ` Filter Pack (from)—(to)— <br /> Bentonite <br /> from) (to)Bentonite (from) (to) <br /> Inspector. AAMYx I_ Grout (from) 8 (to) _ <br /> Drilling rig type <br /> Permit No. 3 O�$ I Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> DrillingCompany:–SC^YtAAA (ten .�vne . <br /> Driller. ( nkAC.l casing <br /> IL height <br /> Consultant_ 4 �� d <br /> Geologist SCa+� . <br /> A5CVE-G8C4JND Ct4a7S1Y30X <br /> COM?L_�t ION COMPL_smN <br /> SPECIAL PERMIT INFO. Grcurd Sutan <br /> Distance to server line grout <br /> Domestic well on site - ( [lt ) _� <br /> If yes, location stance - <br /> f <br /> C <br /> SAMPLING <br /> c <br /> Holding Temperature <br /> Method aI <br /> Screening Method -i= — <br /> Tracking Sheet - ( y/ n ) <br /> 2z ft <br /> SPOILS n <br /> Storage Method ,(7u MATERIALS/DEVEI.OPMENT <br /> Contamination Noted - y/n) '" <br /> Storage Locarion G�' Casing type Z ` ivt,t d4l <br /> Blank �rft. Screen <br /> GROUTING Slot sizeo;_((�..X <br /> Bags cement <br /> Depth to water Buckets bentonite <br /> Mix Ratios ( 20 Bags sand/gravcl <br /> Installation Metho Suzrer Pack type/size r i <br /> Surge Block: • (y n ) <br /> Quantity Installed }� g�Q . Discussed with geo tst: . (y� <br /> EH 29 29 Type of method <br />