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MONITORING WELL INSTALLATION REPOnt' <br /> Date: / YUY !�/, 6 T CONSTRUCTION <br /> Premise Address : Total Depth l b� <br /> Screen Length (from) b (to) <br /> Well No. : 16ak, / Filter Pack (from) (to) <br /> Bentonite (from) <br /> � T (to) <br /> Inspector: Grout (from) (to) <br /> [ / Drilling rig type <br /> Permit No. �jiZ Auger O.D. I .D. <br /> / 5r Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: C7_�- <br /> Driller: L/je J& ' CN - �� casing <br /> / _ { height <br /> Consultant_ �]'6 G T <br /> Geologist � �/Lect,6 <br /> ABOVE-GROUND CtIA75TY-80X <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Sumacs <br /> 7 r <br /> Distance to sewer line of01I <br /> Domestic well on site - ( y n tt <br /> If yes, location and distance - � 7V n <br /> M <br /> _ <br /> SAMPLING dotted = 4 c <br /> �U - tac5on _ --- <br /> Holding Temperature <br /> ack <br /> Method — �'vlw P <br /> Screening Method � ^ <br /> Tracking Sheet y n ) o <br /> SPOILS ` <br /> Storage Method �J 5Z //IJP e L �u e c" MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) <br /> Storage Location Casing e 2r / / <br /> th <br /> Blank ft. Screen 46 ft. <br /> Slot size iO26 <br /> GROUTING Bags cement <br /> Buckets bentonite 2 <br /> Depth to water ~" Bags sand/gravel DO <br /> wee <br /> Mix Ratios 30 Filter Pack type/size <br /> Installation Method - Surge Block: - ( y n <br /> Quantity Installed SSr rA7T l Discussed with geo ogist: - ( y / n ) <br /> Type of method <br /> EH 29 29 <br /> I <br />