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MONITORING WELL INSTALLATION REPORT <br /> Date: 311 / CONSTRUCTION �ac/C,L,��� d <br /> 137&e d 14^AJAV0 5 t i -1-0371 <br /> Premise Address: �. �4n� L j—&�?r ,nom `"' Total DepthScreen `f <br /> Well No.: j� Filter Pack (from) 2? (to) 37 <br /> (from) :L S (to) 37 <br /> Bentonite (from) .3 (to) els' <br /> Inspector: Grout (from) rA(e- (to) -23 <br /> Drilling rig type KalLVW i .^ sk -- <br /> Permit No. Auger O.D. 2 I.D. <br /> �� Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> n height <br /> Consultant <br /> Geologist Q .. <br /> —QW—f <br /> ABOVE-GROUND <br /> COMPLETION CHRISTY-BOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Suriacs <br /> Distance to sewer line Grout <br /> Domestic well on site - (y/ n ) 2 ft <br /> If yes, location and distance - <br /> `u <br /> SAMPLING <br /> aac'on <br /> Holding Temperature <br /> Method __ gmw Pack <br /> Screening Method <br /> Tracking Sheet - (y/ n) r <br /> -32 ft. Itt. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) tl PYG <br /> Storage Location Casing type <br /> Blank ft. Screen '10 ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />