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MONITORING WELL INSTALLATION REPORT <br /> Ole� l X12.Z- l �.2 <br /> Date: CONSTRUCTION <br /> i <br /> Premise Address: -S(b ��U — 0 12& � <br /> � _Vb Total Depth r <br /> Screen Length (from)'� <br /> / Z (to) 2- <br /> Well No.: Filter Pack (from) Z(to) 1&6.2— <br /> Bentonite (from) 2. (to) &P4,157 <br /> Inspector: Grout (from) / ��• (to) <br /> Aq' Drilling rig type <br /> Permit No. �/� 2 Auger O.D. " I.D. <br /> tove i <br /> Completio - hristie box (circle one) <br /> Drilling Company: � <br /> C � <br /> x,611- LTA'(" � I _ 2 <br /> Driller: 4casing <br /> height <br /> Consultant � <br /> Geologist ( -- T <br /> /ABOVE-GACUND CNAtSTY-80X <br /> COMPLETfCN COMPL_=nCN <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line gr <br /> out <br /> Domestic well on site - (y/ n ) �_.ft. <br /> If yes, location and distance - ft- <br /> ft. <br /> pC <br /> SAMPLING �Iorni <br /> sacicn —_ <br /> Holding Temperature gmvW <br /> Method F <br /> Screening Method — <br /> :C: <br /> Tracking Sheet - ( y/ n ) <br /> ft. <br /> SPOILS <br /> Storage Method MATERIAI,S/DEVEI.OPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type 1 <br /> Blank_ ft. Screen ZO ft. <br /> Slot size <br /> GROUTING ��� Bags cement I <br /> 6 94- Buckets bentonite <br /> Depth to water �! Bags sand/gravel <br /> Mix Ratios X } 12 Filter Pack type/size 3 <br /> Installation Me d Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />