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MONITORING WELL INSTALLATION REPORT <br /> CONSTRUCTION <br /> Premise Address: L �tj(r5d�-) Total Depth g Z <br /> y 2�N r 2 Screen Length (from) (to) <br /> Well No.: Filter Pack (from) '- 5' (to) 55'-52' O <br /> BentoInspector: Grout (from) <br /> (from) 2-_ (to) OS <br /> Drilling rig type --R (o0 VYl t N (1.e rAl2-y <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: <br /> C Completion tove pi christie box (circle one) <br /> Driller: casing <br /> T height <br /> Consultant <br /> Geologist_ le'.'� .- <br /> ABCVE-GRCUND <br /> CCMPLET{ON Ci-(FifSTY-80X <br /> COMPLEEMCN <br /> SPECIAL PERMIT INFO. Ground Sudws <br /> Distance to sewer line orcut <br /> Domestic well on site - (y/ n ) T .ft. <br /> If yes, location and distance - ft. <br /> ft. <br /> - O <br /> C <br /> SAMPLING <br /> socicn — <br /> Holding Temperature <br /> Method ' — gmvw pack_ <br /> Screenin;Method <br /> Tracking Sheet - (y/ n ) r' _ <br /> —ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y d <br /> Storage Location Casing type PVL 4 <br /> Blank ft. Screen l b ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water FIS&- Bags sand/gravel <br /> Mix Ratios Filter Pack type/size_ b <br /> Installation Method Surge Block: - ( y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />