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MONITORING WELL INSTALLATION REPPRT <br /> Date: G' (�% Q CONSTRUCTION <br /> Premise Address: CG�=1 jzj� Total Depth e. �;<1l Ly '2 <br /> ' 7 Screen Length (from) (to) <br /> Well No.: C - Filter Pack (from) (to) <br /> Inspector: 0 C (� Bentonite (from) (to) <br /> Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: .w:S H14 Completion - Stove pipe/christie box (circle one) <br /> Driller:_ 'd'/L'e_ casing <br /> f <br /> Consultant T height <br /> Geologist_ <br /> ABOVE-GROUND <br /> (,"qtLam''.fir 31), lb y COMPLETION CHRMTY-SOX <br /> SPECIAL PERMIT INFO. Ground Sones COMPLETION <br /> Distance to sewer line A/ ti grout <br /> Domestic well on site - (y/ n) fizz-i�'r�•�t� ���5 S•b►'� ft. <br /> If yes, location and distance - y <br /> 7C' _ n' <br /> !iE�►rfc••zv r'T h�t� 7"tJ � ., i�����1� <br /> r <br /> SAMPLING <br /> 0 <br /> ( L Oslottod c <br /> aocdon <br /> Holding Temperature <br /> Method _ VZVW pack <br /> Screening Method 'rc' <br /> Tracking Sheet - Cy/ n ) <br /> ft. — 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 /> Type of method <br /> EH 29 29 <br />