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v MONITORING WELL INSTALLATION REPORT <br /> Date: cl -21`i3 <br /> CONSTRUCTION <br /> Premise Address:_3UR - . (� B`c jZ Total Depth 31( <br /> Screen Length (from) ld (to) <br /> Well No.:_ Filter Pack <br /> . (from) <br /> Bentonite' ) <br /> Inspector: _� <br /> (ttoo <br /> Grout (from) (to) <br /> Permit No. Drilling rig type oT <br /> Auger O.D. I.D. <br /> k. <br /> Drilling Company.. 1 <br /> Completion- Stove pipe/christie box�(circle one) <br /> Driller: L <br /> casing <br /> Consultant <br /> 1)ftfCL V t"- '4"Ll/W � height <br /> Geologist &:k <br /> ABOVE-GROUND <br /> coMPLETION CHRISTY-Bcx <br /> SPECIAL PERMIT INFO COMPLETION <br /> Ground surface <br /> O <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n) <br /> If yes, location and distance - 1 T g <br /> t D ft ft. <br /> — e - <br /> SAMPLING <br /> . slatted = c <br /> Holding Temperature <br /> Method ,; <br /> Screening Method = <br /> Tracking Sheet - (y/n) <br /> 3-f e <br /> SPOILS TM' <br /> Storage Method j31 A)NMATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) <br /> Storage Location Casing type- j �F°VC <br /> Blank_ R7 ft. Screen �y ' fr, <br /> GROUTING Slot size_p •o :o <br /> Bags cement (y-?1 <br /> Buckets bentonite <br /> Depth to water L <br /> Mix Ratios <br /> Bags sand/gravel- /Z Installation Method Filter Pack typesize ='3 $I�+L <br /> - - -- -- — Surge.Block:_-_(-y./_n-) <br /> Quantity Installed ---- <br /> Discussed --- <br /> with geologist: - (y/ n ) <br /> EH 29 29 Type of method <br />