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MONITORING WELL INSTALLATION REPORT <br /> Date: �P ' 4 CONSTRUCTION <br /> aLOuG-F1' <br /> Premise Address:����1 -CC�L�I�LI� + - J � Total Depth 4 L5'a. Z <br /> -p Screen Length (from) 3 f?p (to) 3'-:5 <br /> Well No.: � Filter Pack (from) ? - O (to) <br /> I( I Bentonite (from) 28. 5 (to) 2(0 <br /> Inspector: C Grout (from) 2-(v _(to) U <br /> _ Drilling rig type "& <br /> Permit No. Auger O.D. q" I.D. <br /> Drilling Company: <br /> CCompletion a pip christie box (circle one) <br /> Driller: 1 Y / height casing <br /> Consultant <br /> GeologistWL VJ •- T <br /> A80VE.G8CUND CHRZTY-80X <br /> COWLETCN COMPLEMN <br /> SPECIAL PERMIT INFO. Ground Sumac* <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - (y 7n ) ft. <br /> If yes, location and distanc f2. <br /> ft. <br /> d <br /> SAMPLING sloro.! w <br /> .:r <br /> socicn —_ <br /> Holding Temperature :': <br /> Method — F <br /> Screening Method <br /> Tracking Sheet - ( y/ n ) _ <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n if C <br /> Storage Location Casing type _ <br /> Blank ft. Screen <br /> Slot size : O2- <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water A Bags sand/gravel <br /> Mix Ratios v43 ti Filter Pack type/size Jt3 /i <br /> Installation Method Surge Block: - 6� ti ) <br /> Quantity Installed Discussed with ge logis : - (� n ) <br /> Type of method <br /> EH 29 29 <br />