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i <br /> MONITORING WELL INSTALLATION REPORT <br /> Date : q l CONSTRUCTION <br /> Premise Address : I RJB 4A V Total Depth DC7 <br /> Screen Length (from) 3v ' (to) ry t <br /> Well No. : r" W - 2 Filter Pack (from) 315111 (to) Sra <br /> Bentonite (from) d- 4t;- (to) SV <br /> j Inspector: k"�A r a. . . Grout (from) (to) <br /> Drilling rig type <br /> Permit No. S 1 S C\, I Auger O.D. I .D. <br /> Completion I,, Stove pipe/christie box (circle one) <br />' Drilling Company: ILS 'T <br /> Driller: ( Csn,c ( 1 casin <br /> height <br /> Consultant � a'l in.Sn.. <br /> Geologist ( 011`1n qto:?C/1 _ - <br /> A80VE-GROUND <br /> COMPLETION C1PIAISTY-Box <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line aro"( <br /> Domestic well on site - ( y / n ) Zg n <br /> If yes, location and distan - <br /> �6 <br /> Ile <br /> SAMPLING = <br /> slotted — c <br /> sec5on — <br /> Holding Temperature <br /> vel pack <br /> Method = 9" <br /> Screening Me s' <br /> Tracking eet - ( y / n ) <br /> = 5 U n, <br /> SPOILS <br /> Storage Method � MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( yn <br /> Storage Location [OC,5 \ w Casing type Z PVi_' <br /> Blank 30 ft. Screen ft. <br /> Slot size o2D <br /> GROUTING Bags cement <br /> Buckets bentonite I <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - ( y / ti <br /> Quantity Installed Discussed with geologist: - ( y <br /> Type of method <br /> EH 29 29 <br /> az <br />