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MONITORING WELL INSTALLATION REPORT <br /> �� /l7 'Jr { '� CyJr✓/�cd v f l -ell <br /> Date: /9ys� CONSTRUCTION <br /> Premise Address: 7e�/ /C� �Total Depth � <br /> Screen Length (from) (to) <br /> Well No.: -2 Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. /,fs= z 'c I.D. <br /> �1 <br /> Drilling Company: Completion - Stove pipe/christie box (circle one) <br /> �y G–E —.�,.�r�u,/Jy�L�( <br /> Driller: <br /> ,2l//"1 casing <br /> height <br /> Consultant <br /> Geologist ,y��C�' <br /> —QV-f <br /> _A -GROUND <br /> '✓O ✓� S C fCK iH M?1.ETION CNAIS7Y-80X <br /> SPECIAL PERMIT INFO. l" ✓` J' �/"l "J " JJ Ground Surfacs COMPLETION <br /> Cwtacc .ft /a,,n7s/— le-,& lrws f�s"P"/'y <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - n• <br /> ft. <br /> r <br /> SAMPLING <br /> 0 <br /> sbttvd — E <br /> soctlon — <br /> Holding Temperature = <br /> Method = Pack <br /> Screening Method — <br /> Tracking Sheet - ( y/ n ) _ <br /> = ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - ( y/ n ) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> ll// Type of method <br /> EH 29 29 i i��✓Gt a"s `po S 7i ;s <br />