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MONITORING WELL INSTALLATION REPORT <br /> Date: LO' CONSTRUCTION <br /> Premise Address: Total Depth - �4�p <br /> Screen Length (from) l8 .'S (to)_ I69 <br /> Well No.: Filter Pack (from) 3190- 1b4 (to) � Ito9-lbZ <br /> Bentonite (from) I Lo Z (to) 15 <br /> Inspector: _ r,. `il' Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> DrillingCompany: <br /> n G O� . Completion - Stone-lei (circle one) <br /> (� lJX L. <br /> Driller: casing <br /> 7_ height <br /> Consultant -P.(/1'q '4 <br /> Geologist 7//,1 _EWT <br /> ABOVE-GACUND <br /> COMPLETION CNASST'Y-80X <br /> COMPL.EnCN <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line grout <br /> 'LL1 <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - <br /> ft. ft. <br /> O <br /> L^ r <br /> SAMPLING IQQLID G (to <br /> 0 <br /> slot•v.! <br /> socicn '— <br /> Holding emperature St v; = qM�PackMethod <br /> Screening, ethod <br /> Tracking Sh et - (y/ n ) <br /> ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y <br /> Storage Location Casing type V <br /> Blank ft. Screen — ft. <br /> Slot size 0 D Z <br /> GROUTING -1b �aG� Bags cement <br /> I Buckets bentonite <br /> Depth to water__]�3 Bags sand/gravel <br /> Mix Ratios _ Filter Pack type/size t>u a boy --e- <br /> Installation Method Surge Block: - ( y/ n ) <br /> Quantity Installed Discussed with geologist: - E' n ) <br /> Type of method <br /> EH 29 29 <br />