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iwol <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: 7 CONSTRUCTION <br /> Premise Address: �Zd� JJ�I > Total Depth / <br /> Screen Length (from) q1 (to) 13 <br /> Well No.: Filter Pack (from) (to)_ 0 <br /> Bentonite (from) // _(to) <br /> Inspector. Grout (from) !d_ –(to) <br /> Drilling <br /> Drilling rig type 5S!2&1IT <br /> _F- <br /> No. Auger O.D. X V a I.D. <br /> _ CompIction- Stove pip stie bo cle one) <br /> Drilling Company: <br /> casLn <br /> Driller: - he;ght <br /> Consultant fIrr,71 v T� <br /> Geologist ABOVE-GSCUND <br /> COkPLETCN CcMPLEMN <br /> O�+�+.�mcN <br /> SPECIAL PERMIT INFO. G=r>d S xs <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - ( y/ n ) <br /> If yes, location and distance - tL <br /> M.. <br /> V r m <br /> - w <br /> SAMPLING — <br /> aac•,icn F <br /> YN <br /> Holding Temperature C! �s .>. ��Pack <br /> Meths " <br /> Screening Method <br /> Tracking Sheet - / n ) : <br /> r n- M <br /> SPOILS <br /> Storage Method rU4 4e, ' .ter✓ MATERIALS/DEVELOPMENT <br /> Contamination Noted - (� /L <br /> Storage Location ' L Casing type �' � <br /> Blank ft. Screen ft• <br /> Slot size l `� <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios P 46 -� Filter Pack typ <br /> 44-CC e/ ' e <br /> Installation ethod Surge Block: -f / n ) <br /> Quantity Installed Discussed with geologist: n ) <br /> Type of method <br /> EH 29 29 <br />