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N MONITORING WELL INSTALLATION REPORT <br /> Date: 6 I l S 1 6 1 pp CONSTRUCTION <br /> Premise Address : "off o6 U \�n �iYTotal Depth 5 <br /> Screen Length (from) 69 (to) 7 S <br /> Well No. : W1 LA7 Filter Pack (from) >ti (to) � S <br /> Bentonite (from) s— S (to) SI; <br /> Inspector: Grout (from)_ (to) SS <br /> ' of <br /> Drilling rig type <br /> Permit No. ,i I S C1 Auger O.D. LD- <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company:_ " 7 <br /> Driller:_ ci .a r� S& casing <br /> height <br /> Consultant ' ��c�n + T <br /> Geologist (� \ ( 6A �� T <br /> ABOVEGROUND <br /> COMPLETION CNALM-BOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO, Ground Surlace <br /> Distance to sewer line "out <br /> Domestic well on site - ( y / <br /> If yes, location and dis ce - h• <br /> 60 ft. ft. <br /> — c <br /> SAMPLING = <br /> Blotted — c <br /> wc9an <br /> Holding Temperature <br /> Method ` _ V'VS, P <br /> ack <br /> Screening Method = <br /> Tracking Sheet - ( y / n ) <br /> ft* fte <br /> SPOILS <br /> Storage Method�45� S c.c. C lMrn "k MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y n ) <br /> Storage Location a1,. si 64 Casing type 2 PVC <br /> Blank ho ft. Screen � ft. <br /> Slot size ozy <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water v S 3 ' Bags sand/gravel <br /> Mix Ratios y Ga!p orn� lc. / S–{ ra.( r(n ,� Filter Pack type/size � 3 'EZL , . <br /> Installation Method ' * y{ti u Surge Block: - ( y / n ) <br /> Quantity Installed �— Discussed with geologist: - ( y / n ) <br /> Type of method <br /> EH 29 29 <br />