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MONITORING WELL INSTALLATION REPORT <br /> Date: k 1I Z I CONSTRUCTION <br /> Premise Address: \)(LIQ Total Depth S k <br /> Screen Length (from)__ �_(to)�_ <br /> Well No.: t1A W - Filter Pack (from) i I �_(to)�_ <br /> Bentonite (from) Li y _(to) <br /> Inspector: F! A c,1-�- Grout (from) a _(to) O <br /> Drilling rig type <br /> Permit No. l7 7 O Y 3 Auger O.D. I n I.D. <br /> Completion - Stove pipe/christie Lox (circle one) <br /> Drilling Company: C,-t,t2�, <br /> Driller: l Ay\r < T casing <br /> r T <br /> he; <br /> Consultant ('_mv..fs�LG. V <br /> Geologist / ASl e r�U _ F`� T <br /> ABCND C>•WISi'Y-8Cx <br /> COWLETCLE'TION CCMPLEnCN <br /> SPECIAL PERMIT INFO. Grund Scrtacs <br /> Distance to sewer line prcn <br /> Domestic well on site - ( y/ n ) y O Lt <br /> If yes, location and distance - �ft <br /> Fl- <br /> SAMPLING ilonodCE <br /> sacicn <br /> Holding Temperature rry t c = pava G <br /> Method { Qnw� �(e r v e ,;•; <br /> Screening Method P L D <br /> Tracking Shcet - f� n ) <br /> ft. _ = SCS fL <br /> SPOILS <br /> Storage Method G't% eGkA e, MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/moi <br /> Storage Location crvv 4r K, Casing type T' PV C <br /> Blank 4 3 ft. Screen I <br /> Slot size • 01 O <br /> GROUTING Bags cement n.) (-2- <br /> Buckets <br /> 2Buckets bentonite <br /> Depth to water Bags sand/gravel O 5 <br /> Mix Ratios /—. Filter Pack type/size 7 I <br /> Installation Me Surge Block: - ( y <br /> Quantity Installed Discussed with geologist: - ( y C <br /> Type of method <br /> EH 29 29 <br />