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MONITORING WELL INSTALLATION REPORT <br /> (]IDC lAt,.ry <br /> Date: +i� 7�Z l CONSTRUCTION <br /> Premise Address: ��i na.Srr� PQ Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from)—(to)— <br /> Bentonite <br /> from) (to)Bentonite (from) (to) <br /> Inspector. Grout (from)—(to)— <br /> Drilling <br /> from) (to)Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/c�uisti/e box (circle one) <br /> Drilling Company: ����/ <br /> Driller: �_:F casing <br /> height <br /> Consultant <br /> Geologist ABCVE-GRCJNO c4iMM_gox <br /> COMPLETION CCMPLETICN <br /> SPECIAL PERMIT INFO. Ground S�'� <br /> EW-Osb'ftwC� W-0 SG aw <br /> Distance to sewer line 6 PJl % <br /> Domestic well on site - (y/ n) <br /> If yes, location and distance - <br /> y: — <br /> m <br /> M <br /> / O <br /> LLJJdJ —� O <br /> SAMPLINGdoral <br /> I� sac'cn <br /> Holding Temperature Zp _ Sf1Yig Pack <br /> Method = <br /> Screening Method. = <br /> Tracking Shcet - (y/ n ) _ <br /> tt tt. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) <br /> Storage Location Casing type <br /> Blank ft. Screen h• <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonire <br /> Depth to water –2 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 />