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M MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> r` 1 <br /> Premise Address: 2174 S. I Total Depth `l <br /> Screen Length (from) /D (to) <br /> Well No.: /ham _ 9 – Filtet Pack (from)—.I$ (to) C� <br /> , Bentonite (from) 1 � (to) i <br /> -. Inspector: S `l <br /> , oax J W% Grout (from) B , � (to)�_ <br /> Drilling rig type <br /> Permit No. Auger O.D. T.D. �— <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: 87 <br /> Driller: T casing <br /> p height <br /> Consultant_ <br /> Geologist <br /> ASOV€-GROUND C.?iA1ST1'=80X ' <br /> COMPLE ICN' COMPLEM <br /> SPECIAL PERMIT INFO. Ground Swtace <br /> 1 1 <br /> Distance to sewer line_ `o grout <br /> Domestic well on site - ( y <br /> If yes, location and distance 7P fte <br /> - <br /> �ft. <br /> t . <br /> SAMPLING abttad <br /> socron _ . <br /> Holding Temperature N <br /> Method ;: <br /> Screening Method <br /> Tracking Sheet - y n ) \ <br /> U ft. _ ft- <br /> SPOILS 11 -- 1 <br /> Storage Method 1� ` ` L A^S MATERIALS/DEVELOPMENT <br /> Contamination Noted - / n ) <br /> Storage Location ' 0yN5tCasing type <br /> Blank 20 ft. Screen <br /> Slot size re <br /> GROUTING Bags cement <br /> ` Buckets bentonite bw cLA _ <br /> Depth to water " 1 Bags sand/gravel ty <br /> Mix Ratios rp v( Filter Pack type/size 3 <br /> Installation Method Surge Block: - ( y <br /> Quantity Installed Discussed with geologist: n ) <br /> Type of method <br /> EH 29 29 <br />