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MONITORING WELL INSTALLATION REPORT <br /> Date: .4,115-10 }- CONSTRUCTION <br /> Premise Address: 2,31;-00 V'0-55&r (Z"( Total Depth_____Lt; <br /> t <br /> Screen Length (from) S ` (to) I S ' <br /> Well No.: M W Filter Pack (from) } (to) 1s ' <br /> Bentonite (from) (� (to) t <br /> Inspector: I-)%n 1ArC.t &-- Grout (from) (to) 6 <br /> Drilling rig type <br /> Permit No. S`D -3 1 3 Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: {,PI.4-r/Vte r <br /> Driller: P,0',Abell VYIPA,-,e, casing <br /> TffLT <br /> height <br /> Consultant n .r <br /> Geologist n b <br /> ABOVE-GROUND CNRISTY-80X <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Salxe <br /> Distance to sewer line grout <br /> Domestic well on si - (y/ n ) 1 '6 - ft <br /> If yes, locatio d distance - <br /> ft. <br /> = m <br /> O <br /> O <br /> C <br /> O <br /> SAMPLING slotted <br /> vection <br /> Holding Temperature <br /> Method = gravel Pack_ <br /> Screening Me6od <br /> Trac ' Sheet - (y/ n ) <br /> SPOILS <br /> Storage Method SsO�/�rnw� MATERIALS/DEVELOPMENT <br /> ContaminationNoted y n „ <br /> Storage Location Casing type Z <br /> Blank L--2- ft- Screen h. <br /> Slot size 07-0 <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water N S Bags sand/gravel <br /> Mix Ratios Filter Pack type/siz�e �X13 ohF 5 Sa«cam <br /> Installation Method Surge Block: - (y'l'%' <br /> Quantity Installed Discussed with geologist: - ( y)&) <br /> Type of method <br /> EH 29 29 <br />