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MONITORING WELL INSTALLATION REPORT <br /> Date: rJ-2-3- L�I'Ll 4 '1 44 CONSTRUCTION <br /> Premise Address: Total Depth���Z� <br /> Screen Length: (from) 14/. 4 o) Ito <br /> Well No.: Filter Pack (from) 45 to) 1a5-/B <br /> Bentonite (from) 153.3 (to) 191-a <br /> Inspector: Grout (from) 1�1l•9 (to) O <br /> Drilling rig e <br /> Permit No. t2`J 22- Auger O.D. '� I.D. <br /> V } Completion tove pip christie box (circle one) <br /> Drilling Company: 1, ILC�11�,Y,1(lr " <br /> Driller: W casin <br /> 7- height <br /> Consultant IV \ <br /> Geologist --A ._ <br /> ABUVE-GRCUND CHS*TY-80X <br /> COMPLErCN COMPLE710N <br /> SPECIAL PERMIT INFO. Gcourd Surfacs <br /> Distance to sewer line grout <br /> Domestic well on site - (y n) <br /> If yes, location and distance ft. <br /> ft. <br /> 0 <br /> w � <br /> C <br /> SAMPLING :M. _ o <br /> secicn <br /> Holding Temperature = �rav�F <br /> Method _ <br /> ack <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> • _ M <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y nQ�� Ii <br /> Storage Location Casing type 1.Y�C ' - <br /> Blank Z.40 ft. Screen IO ft. <br /> Slot size • z- <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/graveI_ <br /> Mix Ratios _ Filter Pack type/sizeb <br /> Installation Method Surge Block: - y n ) <br /> Quantity Installed Discussed vrith gil', t: - / n ) <br /> Type of method <br /> EH 29 29 <br />