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MONITORING WELL INSTALLATION REPORT <br /> Date:_ <br /> CONSTRUCTION <br /> i <br /> Premise Address:_ 308 Total Depth (*3 <br /> Well No.: ��s-2 Screen Length (from) (PO (to) G 2 <br /> Filter Pack (from) S S (to)G <br /> Inspector: _ "� joltic 00Y Bentonite (from)_ 515 (to) lq� <br /> Grout (from) S< (to) <br /> Permit No. <br /> Drilling rig type- Qa aRAJ <br /> Auger O.D. E4 I.D. <br /> Drilling Company: A W/4 Completion- Stove pipe/chnstie box (circle one) <br /> Drilled:__ M 11 Lil--� Y <br /> 1[* casing <br /> Consultant 14j,.<- <br /> height <br /> Geologist J/ 04I - VI1 LA LRVA <br /> ABOVE-GROUND <br /> CONFLEf10N C iRIST 4M <br /> SPECIAL PERMIT INFO COMPLEnCN <br /> Ground SuAxe <br /> Distance to sewer line Oran <br /> Domestic well on site - (y/n) <br /> If yes, location and distance ft <br /> eo S h. <br /> — m <br /> SAMPLING ; = c <br /> 0 <br /> slotted — c <br /> Holding Temperature aaclon <br /> Method . _ P <br /> Screening Method <br /> Tracking Sheet - (y/n) <br /> SPOILS n• <br /> Storage Method fj I N <br /> Contamination Noted - (y/AsSI MATERIALS/DEVELOPMENT <br /> Storage Location V� <br /> Casing type----2—1. 10 V'( <br /> Blank G4> ft Screen g. <br /> GROUTING Slot size_ m_ 0 <br /> Bags cement <br /> Depth to water Buckets bentonite <br /> Mix Ratios�,g ,a Bags sand gravel / <br /> Installation Method i Q&,yiIFFilter Pack type/size 3 t RN,b <br /> Quantity InstalledwN Y -------.__..._SurgeBlock:__(.y.lff,)_.-- _ <br /> Discussed with geologist: - (y/X) <br /> EH 29 29 Type of method X <br />