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MONITORING WELL INSTALLATION REPORT <br /> Date CONSTRUCTION <br /> CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) 7 (to) <br /> Well No.:, MW - Filter Pack (from)- (to) <br /> Bentonite (from) (to) <br /> Inspector. fd'tc�� . Grout (frog}) <br /> / 2 �O &- q Drilling rig type �J f <br /> Permit No. e, / Auger O.D. it " I.D. <br /> / Completion - Stove pipe/cluistie box (circle one <br /> Drilling Company " ' 61 CSI l <br /> Driller: ��� casing <br /> he±ght <br /> Consultant C � -_ _ <br /> Geologist�l2a o an 4-iw rn - ABOVE-GRCUND J <br /> :STYO <br /> W WLETION <br /> COhIPLrTTTICN'. <br /> SPECIAL PERMIT INFO. < T�GCOund + ` <br /> Distance to sewer line <br /> �-, �L SAPP /11 ptcvt <br /> Domestic well on site - (y/On ) <br /> If yes, location and distance - r n, <br /> 7 h. <br /> - = o <br /> = o <br /> SAMPLING Aonod _ 'E <br /> p6 socicn =' <br /> Holding Temperature `C c/ }. _ G"vatyack <br /> Method<TULA <br /> Screening Method Ph, r <br /> Tracking Shcet - / n) _= <br /> SPOILS �G 2- <br /> Storage <br /> Storage Method efv. cl&it _ MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ ID (AUC <br /> Storage Location 5g;: e Sn x e� Casing e <br /> L) IBlank ft. Screen I h• <br /> Slotsize 0.070 <br /> GROUTING Bags cement f <br /> Buckets bentonite <br /> Depth to water S`D Bags sand/gravel <br /> Mix Ratios /1-�a h Filter Pack type/size I1 — <br /> Installation Method ee- Surge Block: - (y/(�7 <br /> Quantity installed Discussed with geologisr. - O/ n ) <br /> Type of mctiiod �%n- - <br /> EH 29 29 <br />