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MONITORING WELL INSTALLATION REPORT <br /> Date; LX 6 ' �� CONSTRUCTION <br /> Premise Address: 10 fs 4t - �&I �Cl— Total Depth �(n <br /> Screen Length (from) 10 (to) �0 <br /> Well No.: V k5A , 7, ; f- Filter Pack (from) St (to) `(D <br /> Bentonite (from) (to)_ <br /> Inspector: IAnnro. Grout (from) (to) S <br /> Drilling rig type <br /> Permit No. S D S) Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: R S-r <br /> Driller: casing <br /> height <br /> Consultant-'S <br /> Geologist <br /> `s <br /> ABOVE-GFICUND <br /> COMPLETION CHAIM-BOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO, Ground Sauce <br /> Distance to sewer line of0 t <br /> Domestic well on s - (y/n ) 1 tt <br /> If yes, location d distance - tt <br /> Jett. <br /> m <br /> q <br /> - m <br /> C <br /> SAMPLING = <br /> dotted — c <br /> secion — <br /> Holding Temperature _= <br /> Method ft9k <br /> -6 — _ gr,val Pacx <br /> ,�,,,, a�� —_ <br /> Screening Method__fi.p = <br /> Tracking Sheet - y n ) _ <br /> SPOILS <br /> Storage Method S AA,,,h MATERIALS/DEVELOPMENT <br /> Contamination Noted - /n ) <br /> Storage Location Casing type "Sad `(o Pdr <br /> Blank ft. Screen 30 ft. <br /> Slot size % 07-0 <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water /V 6 j Bags sand/gravel <br /> Mix Ratios Filter Pack type/size_1ft-3 <br /> Installation Method Surge Block: - (y <br /> Quantity Installed Discussed with geologist: - <br /> Type of method <br /> EH 29 29 <br />