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MONITORING WELL INSTALLATION REPORT <br /> Date: Z`s CONSTRUCTION <br /> Premise Address:_ rAM,ot Total Depth S <br /> Screen Length (from) 17 5-- ) S•Y <br /> Well No.: (9 5' Filter Pack (from) 5S _(to)_I![.__ <br /> Bentonite (from)_ (to) <br /> Inspector: in 1 Grout (from) (to) <br /> Drilling rig type <br /> Permit No. 9119 Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: aOCd n&t, <br /> Driller:- 15-©IA'- casing <br /> height <br /> Consultant 'Al l^ <br /> Geologist_ �J� n- T- <br /> a�kAAA <br /> ABOVE-GROUND <br /> COM?LETION CNRIM_S0X <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surf aco — <br /> Distance to sewer line grout <br /> Domestic well on sit (y/ n ) <br /> If yes, location distance - ft. <br /> q <br /> C <br /> SAMPLING = ° <br /> �to ttad � <br /> Holding Temperature <br /> Method "Val> <br /> Screening od X16, <br /> Trackin heet y n ) _ <br /> SPOILS <br /> Storage Method w MATE RIALS/DEVELOPMENT <br /> Contamination Noted - n ) <br /> Storage Location cTn S t f-A Casing type -Z- <br /> Blank <br /> Blank (U .5-- ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios--z,- o, 4'PO Filter Pack type/size <br /> Installation Method Surge Block: - ( y/ ) <br /> Quantity Installed Discussed with geovgist: ( y i(57) <br /> Type of method <br /> EH 29 29 <br />