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MONITORING WELL INSTALLATION REPORT <br /> Date: /A CONSTRUCTION <br /> Premise Address: /S ui AR. ri �rrau��ny Total Depth 0 <br /> Screen Length (from)' 'tel (to) <br /> Well No.: k,� w_ 9 (from) �O (to)� <br /> —)/— Filtei Pack <br /> Inspector: J - 7oAk,,M) Bentonite' (from) 3 (to) <br /> Grout (from) I (to) D <br /> SQVU 7v �� Drilling rig type �// augelL <br /> Permit No. Auger O.D. I/)/' I.D. <br /> Completion- Stove pipe istie boa (circle one) <br /> Drilling Company: L-k(-G& A.A./ <br /> Driller: <br /> casing <br /> height <br /> Consultant !� o �L4 <br /> Geologist _ <br /> . .. ABOVE-GROUND <br /> CONPLET{ON C}R4-N-BOX <br /> SPECIAL PERMIT INFO. Grour'd gLW1� COMPLEnON <br /> Distance to sewer line proof <br /> Domestic well on site - (y/n) <br /> If yes, location and distance - ft• <br /> m - <br /> A -- m <br /> ' - m <br /> SAMPLING = <br /> dotted _ <br /> sa.-don - <br /> Holding Temperature <br /> Method = v'ys;PaCR <br /> Screening Method <br /> Tracking Sheet - (y/n) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) (�/ <br /> Storage Location Casing type Y <br /> Blank IW IS ft. Screen--J5 ft. <br /> Slot size O.o/n <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel 13 Be.S $OND <br /> Mix Ratios Filter Pack type/size <br /> Installation Method_ <br /> Quantity Installed Discussed with geologist: - (y/n) <br /> EH 29 29 Type of method <br />