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II <br /> MONITORING WELL INSTALLATION REPORT <br /> i <br /> Date : ez lh { CONSTRUCTION <br /> Premise Address : 4ti1d�) cmc v ( c Total Depth 5�0` <br /> Screen <br /> Well No. : an u ) - 1 S� + wthJ ' l (o Filter Pack (to) �o <br /> (from) 3y <br /> (from) z `6 (to) (70Bento _ <br /> Inspector: I� IMS NL Grout <br /> (from) Z 5 (to) ZK <br /> Ins <br /> P (from) 92 (to) LeV <br /> Drilling rig type <br /> Permit No. i 1 5 `t Auger O.D. T.D. <br /> Drilling Company: <br /> Completion - Stove pipe/christie box (circle one) <br /> 12 �. L <br /> Driller:_ casing <br /> height <br /> Consultant S 4'V <br /> Geologist CC71.� 1ln MUyw <br /> ABOVE-GROUND <br /> COMPLETION CHRISTY-BOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground gLwfxy <br /> Distance to sewer line Grp <br /> Domestic well on site - ( y ) ft <br /> If yes, location and dis ce - L <br /> fin. ft. <br /> — c <br /> SAMPLING = <br /> tlottad — c <br /> a don — <br /> Holding Temperature <br /> erature <br /> ,rel <br /> Method G , - = Qr' P <br /> Screening Method el l7 • — <br /> Tracking Sheet - (Dy n ) 21, <br /> 60 n. <br /> SPOILS <br /> Storage Method K . MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( VA <br /> Storage Location Casing type 7 p V L', <br /> Blank O Screen 2 d ft. <br /> Slot size o z o <br /> GROUTING Bags cement N <br /> Buckets bentonite <br /> Depth to water /V S 77 Bags sand/gravel <br /> Mix Ratios y -sl � Gni nn 1��� 12SV — 1 Filter Pack type/size <br /> Installation Method n�nnec f ' Surge Block: - ( y / n ) <br /> Quantity Installev 6kcsn Discussed with geologist: - ( y / n ) <br /> Type of method <br /> EH 29 29 �+ / <br /> O1 ( / 07 /UW ..dd-/5 <br />