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MONITORING WELL INSTALLATION REPORT <br /> Date: 14 (0 5s CONSTRUCTION <br /> f <br /> Premise Address: q!oll I�wn jc, — YLa Total Depth �� <br /> Screen Length (from) /cc) (to) <br /> Well No.: eW- 12 6 Filter Pack (from) 5 $ (to) 57-1 <br /> Bentonite (from) S G, (to) SES <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. S Cl3 OF Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> ^ height <br /> Consultant <br /> Geologist �� �G(4Q. ABOVE-GROUND T <br /> COMPLETION CHRIM43OX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surfxs T <br /> Distance to sewer line grout <br /> Domestic well on site - n) 5-6, tt <br /> If yes, location andyli tance - <br /> � _bCLft. ft. <br /> q <br /> O <br /> C <br /> SAMPLING stoned <br /> secton 'y <br /> Holding Temperature <br /> gravol Pack <br /> Method _ <br /> Screening Me <br /> Tracking Sheet - ( y/n ) : _ <br /> r tt. <br /> SPOILS <br /> Storage Method s 1n[n.,—,& MATERIALS/DEVE 101, T <br /> Contamination Noted - (y/ n�L) „ '� <br /> Storage Location lnr IS1 FT ' Casing type 6 5JP%v% S-�-dSer�-e. <br /> Blank r)op,}W l 5 e t; Screen 2A ft. <br /> Slot size •6 I D <br /> GROUTING Bags cement N !D <br /> Buckets bentonite_ <br /> Depth to water 2 r Bags sand/gravel ti <br /> Mix Ratio,, f-tA Gu NzSyt4ii ) Filter Pack type/size i 12 earn v�Q <br /> Installation Method�� Surge Block: - ( y/ n ) <br /> ft-e <br /> .� <br /> Quantity Installed N - _ Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />