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MONITORING WELL INSTALLATION REPORT <br /> Date: 7 L L CONSTRUCTION <br /> Premise Address:, f 7a k.J. Total Depth "1 <br /> t Screen Length (from)_ 1, —(to) 42 <br /> Well No.: Filter Pack (from) °l _(to) 4t l <br /> 1 Bentonite (from) at t _(to) 9'1 <br /> Inspector: hs Grout (from) __(to) o <br /> —M Drilling rig type 4 ew�..� n•hc <br /> Permit No. t/ t7 t7 S d `� Auger O.D. S I.D <br /> Completion- Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> Consultant <br /> -f height <br /> 71. <br /> Geologist 1P�°`' �`' s <br /> ABOVE-GROUND CtiMM-BOX <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface " <br /> Distance to sewer line pr out <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - <br /> r Z ft. <br /> • <br /> C <br /> O <br /> SAMPLING stored — c <br /> stiction <br /> Holding Temperature "s. = gnrrA pacfc <br /> Method <br /> Screening Method <br /> Tracking Sheet (y/n) <br /> it. V <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type Qy �— <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement 1l G5 ay(: <br /> Buckets bentonite <br /> Depth to water Y.Ca. Bags sand/gravel t on_ <br /> Mix Ratios A !ZMrL *o-'S 30 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 /> e _ <br />