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MONITORING WELL,INSTALLATION REPORT <br /> Date: <br /> CONSTRUCTION <br /> Premise AAddress: Total Depth <br /> Well No.: r-) -- LD 0 Screen Length (from) _y a (to) 3` <br /> Filter Pack (from)_ 4'v? a (to) '3 <br /> ��,0�,.1 n VN\ 1� Bentonite (from) 30 (to)Inspector: I OEC►• Grout (from)-_LN <br /> (to) rte. <br /> 1 �C� Drilling rig type�� , rr — 1 x i 6 --r- <br /> Permit <br /> No. Q Auger O.D. I <br /> Drilling Company: _P 1 Cs ' Completion- Stove pipe/ •stle o (circle one) <br /> t 1i``tG <br /> Drillez:_ <br /> casing <br /> height <br /> Consultant ('A�� <br /> Geologist <br /> ABOVE-GROUND CNAIS'tY-BOX <br /> cowLETION <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Grour)d Surface <br /> Distance to sewer line grout <br /> Domestic well on site - (y LA <br /> If yes, location and distance - ft. <br /> ft. ft. <br /> ,a <br /> SAMPLING <br /> 8 to tied .. <br /> ta•cdon = <br /> Holding Temperature n <br /> Method = V"'S4 Pack <br /> Screening Method "` _ <br /> Tracking Sheet (y/n) r� <br /> SPOILS <br /> Storage Method �>�-' - rbc. �r`'�'�'"�" MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) ---7 i ( l <br /> Storage Location Ac�C I Q.G�1 � _ Casing type �`���C- —1 C V�-+ <br /> Blank I)ER ft. Screen 1 C7 ft. <br /> Slot size 0.01D <br /> GROUTING Bags cement <br /> Buckets bentonite 1 ✓ ' <br /> Depth to water '!Jo Bags sand/gravele.7- %jXlb ^c, <br /> Mix Ratios Filter Pack type/size-W'1_7 ,rai­;. <br /> Installation Method_ "rrw�y�r� �, _ _Surge Block:_- Cy -- <br /> Quantity Installed Discussed with geologist: -oly n) <br /> Type of method <br /> EH 29 29 <br />