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MONITORING WELL INSTALLA'T'ION REPORT <br /> Date: CONSTRUCTION <br /> 2 Q Total Depth 4S �G�F <br /> Premise Address: yScreen Length (from) 45 1- (to)_ <br /> SfaGK n Filter Pack (from) S Q,1 (to) 2 <br /> Well No.: - Bentonite (from) .23 4 ,er(to) <br /> -�- Grout (from) -21 (to) 0 r <br /> Inspector. Drilling rig type 6 <br /> Permit No. <br /> 3 3 860 Auger O.D. I.D. <br /> Completion - Stove pipe/diristie box (circle one <br /> Drilling Company: <br /> Driller: To V1 ),Ora MADcasing <br /> r II he,ght <br /> Consultant Oe-o <br /> Geologist <br /> COMPl..t'tlON CKRIM-20X <br /> cOMPUMC <br /> SPECIAL PERMIT INFO.Surfer <br /> grcut <br /> Distance to sewer line <br /> Domestic well on site - (y/ n) 2'1 Domestic <br /> yes, location and distance - -23 ft. <br /> a�5 ft. <br /> 7.f- u <br /> O <br /> SAMPLING �laroi Y G <br /> t�Ctcn _ <br /> •H � <br /> Holding Temperature NA P--"* <br /> Method M A — <br /> Screening Method NJ b <br /> Tracking Shcet - (y/ n) �` — <br /> fi <br /> 4 <br /> SPOILS <br /> Storage Method 55 1 a ri�S MA'I•ERIALS/DEVELOPMENT <br /> Contamination Noted - y/ n) Se joleq p <br /> Storage Location J> -L S: Casing type <br /> Blank -2S ft. Screen 2 U ft. <br /> Slot size 02 0 i nele <br /> GROUPING B cement <br /> Pits bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios w�t�e r Filter Pack type/size 4 3 <br /> Installation Metho Surge Block: - y:�Y n) <br /> Quantity Installed Discussed with geologist: - y n ) <br /> Type of method r <br /> EH 29 29 <br />