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MONITORING WELL INSTALLATION REPORT <br /> Date: a/t(a -;?-► lq l2-q b //' CONSTRUCTION <br /> Premise Address: ��,b eo S k/� Total Depth __V#A-I IM s 7 S / <br /> Screen Length (from) (to) <br /> Well No.: s Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector:id IIr Grout (from) (to) <br /> Drilling rig type <br /> Permit No. 5R- 33 2, 0 Mi 0-� Q?I S'- Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company:_ <br /> Driller: casing <br /> S-t� jFLT- <br /> 7" <br /> height <br /> Consultant <br /> ff— <br /> Geologist <br /> ABOVE-GROUND CNAISTY-BOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. �� Ground Surfaces COM _ <br /> ON <br /> Distance to sewer line / L r NI uu�Jl out <br /> Domestic well on site - tt <br /> If yes, location and distance - <br /> tt. <br /> a <br /> t1)1A <br /> SAMPLING slotted <br /> ssc�on <br /> Holding Tempera e <br /> Method = fMY64 Pack <br /> Screening Metho <br /> Tracking Sheet (y/n) <br /> SPOILS <br /> Storage Method d-'--' Sett' MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( / ) 11 PVy <br /> Storage Location�� 2 C Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> p i Buckets bentonite <br /> Depth to water ! Bags sand/gravel <br /> Mix Ratios M Filter Pack type/size <br /> Installation Method h t� Surge Block: - ( y/ n ) <br /> Quantity Installed Discussed with geologist: -©/n ) <br /> Type of method <br /> EH 29 29 <br />