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MONITORING WELL INSTALLATION REPOj�r <br /> Date: a CONSTRUCTION <br /> 10 <br /> Premise Address: 110.06-7— Total Depth <br /> ZY9 Screen Length (from) _(to)� <br /> Well No.: �L Filter Pack (from) 2-95 (to) <br /> Bentonite (from) 74 (to) <br /> Inspector: Grout (from) I ff (to) <br /> Drilling rig type 41"-C- 5 <br /> Permit No. �Y�03/ Auger O.D. q— I.D. <br /> /} Completion - Stove pipe/christie box (circle one) <br /> Drilling Company:_6 - <br /> Driller: f 2- casing �\ <br /> height <br /> Consultant <br /> Geologist JVG� T <br /> ABOVE-GROUND CNRtSTY-Sox <br /> COMPLE CN COMPLEnCN <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line �f0� <br /> Domestic well on site - (y/ n <br /> If yes, location and distance - 2Z ft. <br /> ft• <br /> Z ft. <br /> SAMPLING slotted = ' <br /> a^ sacdon <br /> Holding Tempera e C... = grz,�Pack <br /> Method y <br /> Screening Method <br /> Tracking Sheet - y n ) \ _ <br /> '715 ft. <br /> SPOILS - �j /� <br /> Storage Method �S -C D � GX MATERIALS/DEVELOPMENT Z/i 0o <br /> Contamination Notey Pn JStorage Location /fCu.�- Casing type f V 1. I'd Z !" b O P <br /> Blank Z 9 ft. tcreen 2- <br /> Slot <br /> Slot size /Ll/GA-6 g" <br /> GROUTING y 11*ags cement 57 <br /> Buckets bentonite 1 Z <br /> Depth to water Bags sand/gravel <br /> Mix Ratios I'X 7 Filter Pack type/size Z IL <br /> Installation Method Surge Block: - (y(7771 <br /> Quantity Installed Discussed with geo -gist: - ( / n) <br /> Type of method <br /> EH 29 29 <br /> �zs <br /> �12,6 2 o 'P7 P/ <br />