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✓ MONITORING WELL INSTALLATION REPURT <br /> Date:_ CONSTRUCTION <br /> Premise Address: // / T Z 7� Total Depth �a <br /> �/ Screen Length (from) �s (to) fav <br /> Well No.: A/V /O Filter Pack— (from) Se (to) 19-10Bentonite (from) 5-(e (to) 5� <br /> Inspector: ��� Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: �C'oo�04A d � <br /> �'ay.J..�Eir CGcoiky G — S4 <br /> Driller: k ,2L0 casing <br /> C�� � height . <br /> Consultant <br /> Geologist T <br /> ABOVE-GROUND <br /> COMPLETION CHRIST 4= <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Sura <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n) 1 ft• <br /> If yes, location and distance - <br /> ft. <br /> a <br /> SAMPLING = <br /> slottedteclon <br /> c <br /> Holding Temperature <br /> Method _ 71"W Pack <br /> Screening Method <br /> Tracking Sheet - (y/n) _ <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) <br /> Storage Location Casing type PUC Z <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement 47/L 9 AO wd A„e►7F 1" <br /> Buckets bentonite T '� <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n) <br /> Quantity Installed Discussed with geologist: - (y/n ) <br /> EH 29 29 Type of method <br />