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MONITORING WELL INSTALLATION REPORT <br /> Date:iSC I I O } CONSTRUCTION <br /> i <br /> Premise Address : qoL Total Depth <br /> Screen Length (from) 60 (to) <br /> Well No . : D4 IAJ - I 5( Filter Pack (from) A�rtf (to) <br /> Bentonite (from) (to) S- so <br /> Inspector: l ) tAAnco. L Grout (from) (to)� <br /> Drilling rig type <br /> Permit No. S l S r'I I Auger O.D. I .D. <br /> Drilling Company: 125 I Completion - Stove pipe/christie box (circle one) <br /> Driller: G � f V <br /> casing <br /> height <br /> Consultant S <br /> �CWT <br /> Geologist Ccn \ h i ti Ct C .L� <br /> ABOVE-GROUND <br /> COMPLETION CNA M43OX <br /> SPECIAL PERMIT INFO, Ormond SuAacs COMPLEIMN <br /> Distance to sewer line "out <br /> Domestic well on site - ( y / n ) <br /> If yes, location and dist S ft <br /> i <br /> SAMPLING = <br /> slotted _ B <br /> wc5on <br /> Holding Temperature Gv\ 1 �CNVAW_ P <br /> ack <br /> Method <br /> Screening Method =_ <br /> Tracking Sheet - ( y / n ) _ <br /> SPOILS <br /> Storage Method _SS MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y n ) <br /> Storage Location n ti $ 1 -64 Casing type Z " PV C <br /> Blank 6 ft. Screen <br /> Slot size oz.o <br /> GROUTING Bags cement �/ <br /> Buckets bentonite_ <br /> Depth to water w 5- 3 Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method ( / ,� A . Surge Block: - (� n ) <br /> Quantity Installed Discussed with geologist: - (C' n ) <br /> Type of method <br /> EH 29 29 <br />