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MONITORING WELL INSTALLATION REPORT <br /> Date: "1 CONSTRUCTION <br /> Premise Address:.`900 CSL-.,es... Total Depth o� . <br /> Screen Length (from)' (to)- _ <br /> Well No.: L� � -3-- Q\44— Filter Pack ..(from) (to)_ _ <br /> InspectBentonite' (from) ' - -(to)--t)-- <br /> or: y n'C; Grout (from) (to) r� <br /> ii Drilling rig type C r�•y-r,�t x,514LA:::_- <br /> Permit No. l Q� � � Auger O.D. <br /> Completion- Stove pipe/ stie box (circle one) <br /> Drilling Cotnp`•'any: ��x��,w c;�l � <br /> Driller: <br /> e. <br /> casipg <br /> height <br /> Consultant_ C-. <br /> Geologist- (!>V-1V'1 • l�Q,,s.'��j�r � ._ <br /> ABOVE-GROUND G�IRlS7Y-80X <br /> comPLETION <br /> SPECIAL PERMIT INFO. GroundSurface COMPLETION <br /> W . <br /> UN- <br /> Distance to sewer line grout well on site - (y n r, <br /> If yes, location and distance <br /> • �ft. fi. <br /> SAMPLING ►.i I Y — o <br /> l glo — <br /> saCion = is <br /> Holding Temperature = <br /> Method ! _ VIVS4 pack <br /> Screening Method — <br /> Tracking Sheet (y/n) <br /> SPOILS <br /> Storage Method 1 ��„S MATERIALS/DEVELOPMENT <br /> Contamination Note - (y n <br /> V Storage Location 1<_ . j ,��� � Casing type <br /> Blank � ft. Screen i� ft. <br /> Slot sizeo ,0,10 '11,-,c--\A- <br /> GROUTING Bags cement <br /> Buckets bentonite_(- 5'( )0 b� �- <br /> vdI�--VlCn; <br /> Depth to water � � Bags sand/gravel <br /> Mix.Ratios-' -4�1 Filter Pack type/size--V L mi:t, LZE <br /> Installation Method_j c,' L j, <br /> Quantity Installed - - -------- -Surge_Block: - (-y-/n) _ <br /> Discussed with geologist: - n) <br /> EH 29 29 <br /> Type of method <br /> ' <br />