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N ' <br /> MONITORING WELL INSTALLATION REPORT <br /> i <br /> Date: % 16" I CONSTRUCTION <br /> Premise Address: Total Depth 4 O < S <br /> Screen Length (from) '). a (to) o <br /> Well No. : Filter Pack (from) 16 t Cto) © • $ <br /> Bentonite (from) (to) I ft <br /> ~Inspector. mpGrout (from) 1 Cto) ) $ <br /> Drilling rig type C M F -- ?5 <br /> Permit No. Auger O.D. FS " I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> DrillingCompan11y. \NEI ) bgNpccpj <br /> Driller: p S � Ya � )P - �-1T casing <br /> J height <br /> Consultant v E•1 !'1�e G>rr �iSv , /�oy�MFiI A <br /> ABOVE-GROUND <br /> COWLETION CtiAISTY60X ' <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Sumacs <br /> Distance to sewer line grout <br /> Domestic well on site - ( y / n ) X� ft <br /> If yes, location and distance - <br /> ZA ft. <br /> E = o <br /> SAMPLING <br /> slotted = <br /> - taction — - <br /> Holding Temperature <br /> li Method _= vivvl Pack <br /> Screening Method = <br /> Tracking Sheet - ( y / n ) �b <br /> SPOILS <br /> I Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y / n ) i <br /> Storage Location Casing type 5 ( ,kc A` ) e `� p <br /> Blank Za ft. Screen . 2 ft. <br /> Slot size mI <br /> .oz 4a <br /> GROUTING Bags cement <br /> Bttekets bentonite IF <br /> Depth to water Bags sand/gravel ) z 0403 C 5 hl ) <br /> Mix Ratios Filter Pack type/size1 s I -vsTcr <br /> j Installation Method Surge Block: - ( y <br /> Quantity Installed Discussed with geologist: - ( y / n ) <br /> Type of method <br /> EH 29 29 <br /> I <br /> i <br /> i <br />