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i <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address: 4� i � tiu 5/ /�L� Total Depth <br /> ll Screen Length (from) a 0 (to) a-o <br /> Well No.: 7 �rr/oc , _ �.l i� = vF 5j"3 e2 Filter Pack (from) L/ U ' (to) !$ <br /> Bentonite (from) / 6 ' (to) / Y - <br /> Inspector: (/Pf, Grout (from) � (to) <br /> DnUng rig type 140110C..? s-fe' <br /> Permit No. 3 � <br /> Auger O.D. e 3w " LD. & <br /> / a7�� - <br /> g <br /> Completion - Stove pipe/chrisne box (circle one) <br /> Drilling Company: <br /> Driller. Lam . height <br /> !�i ! re casing <br /> 76 <br /> Consultant /a iG L <br /> 775 <br /> Geologist <br /> ABOVEwGRCUN!) *C8R <br /> CONFLE,IONL CN <br /> SPECIAL PERMIT INFO. �� Ground Suiaes + <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - ( y / n ) <br /> If yes, location and distance - fL <br /> a <br /> SAMPLING dotted <br /> on <br /> Holding Temperature Pim pack <br /> Method r �7 <br /> Screening Method Oi /) <br /> Tracking Sheet - (y)/ n ) <br /> tL <br /> SPOILS <br /> Storage Method _ MATERIALS/DEVELOPMENT <br /> Contamination Noted - (® n ) <br /> Storage Location C 5:/ Casing type " % v' <br /> Blank a / ' ft. Screen <br /> Slot size 00010 — <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water r _`. Bags sand/gravel• _ w <br /> Mix Ratios Filter Pack type/size �'` � Su <br /> Installation Method ;t&& _ Surge Block - ( / n ) <br /> Quantity Installed Discussed with geologisr.- - (�Y n ) r a uw <br /> Type of method a v <br /> EH 29 29 <br />