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MONITORING WELL INSTALLATION REPORT s <br /> I <br /> 5 �1 fj <br /> CONSTRUCTION <br /> Date : <br /> G�c 5 auaa�✓�.�`s 5 <br /> Premise Address: 7 �l ScrDepth <br /> Screeee n Length (from) (to) YS <br /> BM / 3 Filter Pack (from) NS (to)VV <br /> 33 <br /> Well Nov : Bentonite (from) 2. 3 (to) _ <br /> n Grout (from) /�2n (to) p <br /> Inspector: l O Z /1. <br /> P S � . Drilling rig type <br /> Permit No. /d <br /> Auger <br /> Completion - Stove prpe/chrts[ie box (circle one <br /> Drilling Company: /3 <br /> 20 p casing <br /> Driller: height <br /> Consultant 3J T <br /> S . T <br /> Geologist 3S � VE-GRCONO ��.-aox <br /> oo COWL`ETCN COMPLERCN <br /> SPECIAL PERMIT INFO . Ys A) Ground s <br /> Distance to sewer line <br /> <, 2 grart <br /> Domestic well on site - ( y Ap It. <br /> If yes, location and distance <br /> ft. <br /> y ZS" slonad � <br /> SAMPLING Sa T,k <br /> ( 4S sacicn = �' <br /> Holding Temperature C �� ! _ pavdpaac <br /> Method <br /> Screening Method <br /> Tracking Sheet • (® / n ) <br /> R• 1V It. <br /> SPOILS ° <br /> Storage Method per" °� MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y /Cts) Casing type L <br /> Storage Location elm aa:4 Blank a$ h, Screen h• <br /> Slot size 09 <br /> GROUTING Bags cement <br /> 2 Buckets bentonite � ' <br /> Depth to water ti 33 Bags sand/gravel �- <br /> U � tiwr Filter Pack type/size <br /> Mix Ratios 3 <br /> Ouu Lp- Surge Block: - G/ <br /> Installation Method n ) <br /> Quantity Installed ^� � Discussed with geologist: - a / n ) <br /> Type of method (� <br /> EH 29 29 <br />