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MONITORING WELL INSTALLATION REPORT <br /> Date: + pC t LA <br /> CONSTRUCTION <br /> Premise Address: Total Depth lD <br /> well No.-Dy� L-3 Screen Length (from) (to) <br /> Filter Pack (from) (to) J <br /> Inspector: V{-� Bentonite (from ! (to _ <br /> h� V Grout (from) ' 3 s i_5(to)L-1-- <br /> Drilling <br /> -1•-1 <br /> Drilling rig type C e,.s�rc� �3J40 r^S <br /> Permit No. Auger O.D. I.D. <br /> *, \ Completion- Stove pipe/christie box (circle one) <br /> Drilling Company: I�IC`i--}�f��►L <br /> Driller: ��I ,Q�/ (r_,V1C�1, <br /> � casing <br /> Consultantheight_ ���� <br /> Geologist �►��� � ;G� ._ <br /> A OVE-GROUND CNA1SrY-8aX <br /> b M?LEl'JO N <br /> COMPLEnON <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line grout <br /> Domestic well on site - (y •n) <br /> If yes, location and distance - n- <br /> 5� <br /> SAMPLING I V9 _ o <br /> s Ic[tad E <br /> • sac•�on — <br /> Holding Temperature P <br /> Method = <br /> Screening Method <br /> Tracking Sheet (y/n) <br /> SPOILS <br /> Storage Method <br /> MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y n ` <br /> Storage Location 1. c 1 1tXS Casing type �- <br /> �cst��l �( Blank ft. Screen i p ft. <br /> ` Slot size_ 0. 10 ` <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel Gam' <br /> Mix Ratios Filter Pack type/sized <br /> Installation Method'[ rt v-�v..���� _ S.urge_Block:_(_y. n'- <br /> Quantity Installed Discussed with geologist: - n) <br /> EH 29 29 Type of method <br /> L •...r <br />