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*MONITORING WELL INSTALLATION REORT <br /> Date: 113 1 CONSTRUCTION <br /> G S� <br /> Premise Address: a� Total Depth <br /> Screen Length (from) (to) 4 i _ <br /> Well No.: Filter Pack (from) .s (to) 4 7, b <br /> Bentonite (from) , (to) Y 3, <br /> Inspector: Grout (from) 3. (to) <br /> Drilling rig type <br /> Permit No. "f ` °2 ( Auger O.D. .2 41 I.D <br /> X. <br /> Completion - Stove pipe/ istie bo (circle one) <br /> Drilling Company: LA)nD _ , <br /> Driller: casing <br /> height <br /> Consultant �(' <br /> Geologist �; .QA-) P— C-0� 7 <br /> ABOVE-GROUND <br /> COMW LET{ON CHRISTY-BOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line gf°ul <br /> Domestic well on site - (y/ n ) <br /> ft. <br /> If yes, location and distance - <br /> ft. <br /> ft. <br /> CD <br /> a <br /> C <br /> SAMPLING Monad <br /> &*cion <br /> Holding Temperature = 7A„W Pack <br /> Method <br /> Screening Method = <br /> Tracking Sheet - (y/ n ) <br /> SPOILS <br /> Storage Method =q'v"�2z MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y V <br /> a <br /> Storage Location 3'�'� ��—e-e�� Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement /0 <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 />