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MONITORING WELL INSTALLATION REPORT <br /> Date:_ SC( 7-1 lo`L CONSTRUCTION <br /> Premise Address: ) Total Depth Iz.o ' <br /> Screen Length (from) I lo (to) L <br /> Well No.: hA%A)-I _ 11d Filter Pack (from) 1 O'4 ` (to) I.zd t <br /> Bentonite (from) 1 D`i ' (to)_ I per! <br /> Inspector. AM-Pe=4., Grout (from) -99-' <br /> Drilling rig type <br /> Permit No._ Auger O.D. I.D. <br /> Completion - Stove pipe/clu-istie box (circle one) <br /> Drilling Company: bna�.�l -� a,..a v.�. <br /> Driller: 1'Yn.nr� _ heLght <br /> e±qht <br /> Consultant \ <br /> Geologist_Ndeu,y (',oe) <br /> C— ABCVE-GACUND C7�i7STY-dOX <br /> COIiPL�fiON c:owuL )CN <br /> SPECIAL PERMIT INFO. G=nd Striac� <br /> Distance to server line or0n <br /> Domestic well on - (y/ n ) I aN 1 <br /> If yes, locatio d distance - o <br /> _ Ile ft. <br /> - = a <br /> = m <br /> = o <br /> — c <br /> SAMPLING = <br /> donnd — � <br /> socion •- _ � <br /> Holding Temperature_ (J( = pavd past <br /> Method = — <br /> Screening Meth _ <br /> Tracking Sheet - (y/ n ) _ <br /> zO ft. L=A <br /> SPOILS <br /> Storage Methodl�nApantl MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( / n ) it <br /> Storage Locarion_ nn,_� Casing type 'G uM+blo} !tet w� <br /> Blank I I V ft Screen .p I r7 ft. <br /> 67 <br /> GROUTING Slot size <br /> Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel �g �! z• <br /> Mix Ratios Filter Pack type/size j*bj'El'v <br /> Installation Metho 1 �- M KA if • Surge Block: - (y/ <br /> Quantity Installed �I l h��rn,n Discussed with geol3gtst: - ( y/0 <br /> EH 29 29 Type of method <br />