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MONITORING WELL INSTALLATION REPORT <br /> Date: S� I 'L(� I 1 0 CONSTRUCTION <br /> Premise Address: Total Depth s 5 <br /> Screen Length (from) S (to) S S <br /> Well No.: ) - 5 Filter Pack (from) q Z6 (to) <br /> m) <br /> Bentonite (fro (to) iF __ <br /> Inspector: b P--,A Grout (from) -(to)-- <br /> Drilling rig type <br /> Permit No. S I q9 `3— Auger O.D. I.D. <br /> p Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: 1 /V e l S ko ,t- <br /> Driller: 7_0 i"►�� casing <br /> height <br /> Consultant _ <br /> Geologist <br /> ABOVE-GROUND CNAISTI'80X <br /> CO M?LFTb N COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer 1' grout <br /> Domestic well o e - ( y/ n ) <br /> If yes, locatio d distance - 7, ft. <br /> So ft <br /> = m <br /> b <br /> — m <br /> f c <br /> SAMPLING dotted — <br /> &acaon — <br /> ". .. `Holding,,Temperature (G� �� <br /> Method Gtivel pack <br /> Screening.Method _ <br /> Tracking Sheet y n ) F _ <br /> SPOILS' <br /> a Storage Method- MATERIALS/DEVELOPMENT' <br /> Contamination Noted - n ) <br /> Storage Location riA!jj f;t Casing type 2, 1°V� <br /> Blank 6-0. ft. Screen <br /> Slot S'1Ze '..� d .. y. _... <br /> GROUTING' Bags cement <br /> Buckets bentonite . <br /> Depth to water Bags sand/gravel _ <br /> MixRatios }�2G Filter.Pack type/size <br /> Installation Method Surge Block: - ( y/on <br /> Quantity Installed n. 20 ( Discussed with geologist: - ( yi <br /> Type of method <br /> EH 29 29 <br />