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MONITORING WELL INSTALLATION REPORT <br /> Date:_ I �.c'1 U S CONSTRUCTION <br /> Premise Address:- &v - Total Depth_ t 00 C 1r-, `f�SuG.c <br /> Screen Length (from)_ U_(to)_(0?)Well No.:_ – Z— Filter Pack (from) (Eo).. <br /> Bentonite (from) } (to) _ <br /> Inspector: C , _ Grout (from)_ <br /> 3 l 3 Drilling rig type <br /> Permit No. Auger O.D. D. <br /> jCompletion - Stove pipe christie box (circle one) <br /> Drilling Company: r-1, <br /> Driller:_ casing <br /> height <br /> Consultant 0- '9 <br /> VTA <br /> Geologist_ f2 '� <br /> • <br /> ABOVE-GRCUND C2-R:STY-30X • <br /> �I4�r'l EZfON <br /> CA,�r =-n <br /> SPECIAL PERMIT INFO. Gi=rd sulxt <br /> Distance to sewer line grout <br /> Domestic well on site .- <br /> If yes, location and ante - tt. <br /> -- C <br /> SAMPLING ilaro i ` E <br /> Holding Temperature _ <br /> Method <br /> Screening,Method/ — <br /> Tracking Shc - (Y/ n) =' _ <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination - (y/n) <br /> Storage Loc 'on Casing type Z ` P��C <br /> Blank fc- Screen Z �T• <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite Z,Ar,/e I <br /> Depth to water AJ I Bags sand/gravel S' <br /> Mix Rados ' 7C.6 2 Filter Pack type/size 3,- SZ <br /> ,Installation Method Surge Block: - (y ii) <br /> Quantity Installed Discussed with geologist: - <br /> Type of method <br /> EH 29 29. . <br />