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MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Total Depth <br /> Premise Address: - C <br /> Screen Length (from) /0 (to) <br /> Well No.: 1224d- I Filter Pack (from)� (to)� <br /> Bentonite (from) _%Y (to) <br /> Inspector. i Grout (from) 25' (to) u�" e- <br /> "�' Drilling rig type c � <br /> Permit No. Auger O.D. --5KVx'' I.D. V t- " <br /> Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company: <br /> Driller casing <br /> r77 � height <br /> � � r <br /> � <br /> Consultant Pi/1 Pp - T <br /> Geologist A80VF--G-FtCVNO C-1-S*TY-aCX <br /> OC&VLZriCN COMPLEC-i1C <br /> SPECIAL PERMIT INFO. (3roctnd Surface <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - ( y/ n ) ft. <br /> If yes, location and distance - ft. <br /> ft. <br /> SAMPLING Ot�ol' .baai <br /> soden <br /> Holding Temperature D� —��� = = g"19i pacK <br /> Method tZ-'L/1' <br /> Screening Method = <br /> Tracking Sheet - ( y/ n ) <br /> SPOILS <br /> Storage Method MA7ERIALS/DEVELOPMENT <br /> Contamination Notedn ) <br /> Storage Location Casing type <br /> �� <br /> Blank ?d ft. Screen 3 <br /> Slot size <br /> GROUTING Bags cement <br /> / Buckets bentonite <br /> Depth to water �41 Bags sand/gravel <br /> Filter Pack type/size <br /> Mix Ratios <br /> llation Me od �nom.r.�•� Surge Block: - ( y/ n ) <br /> Insta <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />