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MONITORING WELL INSTALLATION REPORT <br /> Date: <br /> yJ/ CONSTRUCTION <br /> Premise Address: LZ A"111616 ,17, U� Tonal Depth �// <br /> Screen Length (from) N/ (to) <br /> Well No.: 2 ( Filter Pack (from) '�2c " (to) <br /> Bentonite (from) / -7 ' (to) <br /> Inspector: ( c - o/D" Grout (from) / 7 / (to) C c " <br /> Drilling rig type, //e. (. 2 <br /> Permit No% r ) i 1 3 Auger OD. d' %Y I.D. M <br /> Completion - Stove pipe/christie boa (circle one) <br /> Drilling Company: <br /> L vo A4 "rcasing <br /> height <br /> Driller: <br /> Consultant 9 l ♦ T <br /> T <br /> Geologist »p -ll / "-z - <br /> ASCVErGRCUND Ca- RM7 YK30X <br /> C.,I.�L�tICN c,{pj�'i1CN <br /> SPECIAL PERMIT INFO . Ground Surtae+ <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - ( y /Cp) ♦ / '7 fL <br /> If yes, location and distance - I`7 R. <br /> — c <br /> — o <br /> SAMPLING slotted <br /> an <br /> Holding Temperature J-a-e- • = 7XV11 Fesk <br /> Methodt <br /> Screening Method- ,° /:9 _ <br /> Tracking Sheet - ((f'1 n ) <br /> / tL ♦ = tt <br /> SPOILS <br /> Storage Method S s in nGz� MATERIALS/DEVELOPMENT <br /> Contamination Noted - ((y-d n )` <br /> Storage Locarion y .n-LC.` Casing type_ t'C - " <br /> Blank / ' ft. Screen � fr. <br /> Slot size • odo <br /> GROUTING Bags cement w S w ( i e T e a]T <br /> Buckets bentonite / /3u c cR -l- <br /> Depth to waterBags sand/gravel -L <br /> ,g <br /> Mix Ratios / u -F lea 4a QP Filter Pack type/size -;aR <br /> Installation Method / e Surge Block: - ((y)/ n ) <br /> Quantity Installed Discussed with geologist: - C , n ) <br /> Type of method 0 <br /> EH 29 29 <br />