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r <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: ' �3 05 CONSTRUCTION <br /> Premise Address: e �S/ l✓ �J�o _ f� l,,4 Total Depth <br /> Screen Length (from) '� (to)_(_ _ <br /> *A-4,1 ,�-� 7, L 7 Filter Pack (from) (to) X <br /> Well No.: �, =7---- <br /> Bentonite (from) (to) h <br /> I ���^-"off Grout (fro ) (to) <br /> Inspector: <br /> Drilling rig type o <br /> Permit No. Auger O.D. S-" 1�'o ` I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: V, L+ <br /> Driller: casing <br /> height <br /> Consultant TbS4 <br /> Geologist ABOVE-GROUND <br /> CtfCX <br /> CCMPLEfICN I <br /> COMMPLEPLE TIONGround <br /> SPECIAL PERMIT INFO. Surixa <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - (y/ n ) ft• <br /> If yes, location and distance - ft. <br /> ft. <br /> O <br /> _ m <br /> O <br /> SAMPLING 'lotted <br /> Holding Temperature n/I.4 _ gmvw Pack <br /> Method _ <br /> Screening Method <br /> Tracking Sheet (y/ n ) _ <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) 3 u <br /> Storage Location Casing type <br /> Blank_ oft. Screen 2A R- <br /> Slot size -c'2-6 <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size I <br /> Installation Method Surge Block: - ( y n ) /� <br /> Quantity Installed Discussed with geo ogist: -6t q/ n ) <br /> Type of method <br /> EH 29 29 <br />