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MONITORING WELL INSTALLATION REPORT <br /> Date:_ S1 26 p7 CONSTRUCTION <br /> Premise Address: O -.&1VJC,,_ Total Depth `6 Z <br /> Well No.: Screen Length (from). Z <br /> Filter Pack (from)_ (to) <br /> Inspector. Bentonite (from)_ (7S (to)— <br /> Grout (from) 11 ' (to) (,f �_ <br /> Permit No. 7, p-S' 2_Y Drilling rig type� ( 4'1.t � �L--=-04�0� <br /> Auger O.D. I.D. <br /> Drilling Company:-B0oln+, ( rnnri.orti . <br /> Completion - Stove pipe/cluistiebox (circle e) <br /> Driller. ��� <br /> �h casing <br /> Consultant Cyst,.,, Q�,�.� ,4 ,4 <br /> height <br /> Geologist_ (awn rT N� lnntuitn i \ T <br /> AEOVE�ACUND <br /> 0CMPLZD0N elm 30X <br /> SPECIAL, PERMIT INFO. CCMPL--ncN <br /> Ground&rfact <br /> Distance to sewer l n <br /> Aran <br /> Domestic well o to - <br /> If yes, local and distance - It <br /> _ - a <br /> SAMPLING c <br /> _ o <br /> �forad c <br /> Holding Temperaw to — g <br /> Method = LnYdFadc <br /> Screening M od = <br /> Tracking SKet - ( Y/ n ) <br /> SPOILS <br /> Storage Method <br /> Contamination Noted - (y n MATERIAL.S/DEVELOP MENT <br /> Storage Location c <br /> Casing type_ <br /> Blank_ z fc Screen 10' fr. <br /> GROUTING Slot size_ O 20 <br /> Bags cement <br /> Depth to water Buckets bentonite <br /> Mix Ratios Bags sand/gravc] v <br /> LO n FL�g FllerPatktype/size i/1z <br /> Installation Method � — <br /> QuantityInstalled �O >�(� Surge Block: - (y/(f1--P <br /> —�- Discussed with ge0jgist: - ( y/ n� <br /> EH 29 29 Type of method <br />