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MONITORING WELL INSTALLATION REPORT <br /> Date: 9AI CONSTRUCTION <br /> Premise Address: )b26 w W G'13r_n, ajC Total Depth oZSBf P- <br /> Screen Length (from) 0P5'( (to) ;Z `/If <br /> Well No.: Z Filter Pack (from) 5 S (to) ;� 3 9 <br /> Bentonite (from) a 39 (to) 2.3`1 <br /> Inspector: _ J V6FkQw? Grout (from) 1p y (to) r) <br /> Drilling rig type SO N r c- <br /> Permit No. v le Oo 70 3 I 1 Auger O.D. Q 11 I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: CA(5(61 P L' �21 L�, l��, LP, <br /> Driller:_ Irl Bch casing Flush KovN. <br /> height <br /> Consultant _Ean► fc>wskr 1�S�oC�gT� <br /> Geologist L r wy Se'g7T" ._ <br /> ABOVE-G ROUND <br /> COMPLETION CHR fST WX <br /> SPECIAL PERMIT INFO. G=nd Suite COMPLETION <br /> Distance to sewer line Pt- - grout <br /> Domestic well on site - (y/n ) <br /> If yes, location and distance - `1 ft. <br /> ft. 39 ft. <br /> q <br /> O <br /> C <br /> SAMPLING stoned __ s <br /> avcyon — � <br /> Holding Temperature = <br /> Method = Pack <br /> Screening Method — <br /> Tracking Sheet - (y/n ) _ <br /> ASN n. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) <br /> Storage Location Casing type _1 VC Scha 1/0 <br /> Blank 3H ft. Screen /0 ft. <br /> Slot size 040 <br /> GROUTING Bags cement <br /> Buckets bentonite 2 St-AL, <br /> Depth to water Bags sand/gravel I <br /> Mix Ratios Filter Pack type/size ( } 0 Sjgoo <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />