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MONITORING WELL INSTALLATION REPORT <br /> Date: G -//(7l/x,eZW S- / /� s CONSTRUCTION A�pq w dill,zJ �po✓r <br /> Premise Address: ) ty btl"4 l�`e'- fe Total Depth -38 / <br /> l U 2 Screen Length (from) 3 (to) 36 <br /> � <br /> Well No.: rSiCuM.i , Filter Pack_ (from) (to) <br /> ' rr Bentonite (from (to) <br /> Inspector: NG Grout ( ) (to) <br /> Drilling rig e S — <br /> Permit No. ��y s� 3 Z Z Auger O Sr I.D. y <br /> Co etion-Stove pipe/christie b x (circle one) <br /> Drilling Company: S 4 <br /> g 7 ire( 3f38yf` <br /> Driller: casing J <br /> /' height <br /> Consultant ( v v )0-1 06 A CJ T <br /> Geologist �`wb )14 ko OP-7,A - T <br /> ABOVE-GROUND <br /> a1- 37,'{s•�1 Cf- Z7, COh1PLETION CHAISTY BOXCOMPLETION <br /> fr <br /> SPECIAL PERMIT INFO. ' �3�uc 7 SsM vcoU"ll to 38 Ground Surlacs <br /> body fn Well, )°ter/ <br /> Distance to sewer linege-,J far j "kd f grout <br /> Domestic well on site- (y/n) E <br /> If yes, location and distance - ° C� n <br /> SAMPLING slorted <br /> %ra n*•r preSSNer/ 07&cu TD 36 soctlan IF — $ <br /> P = <br /> Holding Temperature d. _ 9m„el Pack <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n) <br /> n. = n. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type <br /> Blank ft. Screen h. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel 3 ��n•>1�n <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/ <br /> Quantity Installed Discussed with o ogist: - (y/n) <br /> Type of met d <br /> EH 29 29 <br />