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MONITORING WELL INSTALLATION REPORT <br /> Date: i Pic) CONSTRUCTION <br /> Premise Address: 1 17. L� Cti) 15 r'j Lf Total Depth 5 1 <br /> Screen Length (from) (to) <br /> Well No.: 1Z io `:t' f- (v Filter Pack (from) X -(to)��' <br /> Bentonite (from) �' (to)_ �4'1 <br /> Inspector: ,,, �� �, Grout (from) $ (to) _ <br /> Drilling rig type <br /> Permit No. O D ZZ. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: JVAa-A <br /> Driller: (til casing <br /> height <br /> Consultant /�C� I <br /> Geologistr_�'� t� ,_ �L L —qVT <br /> n,n r4 L -- <br /> In <br /> ABCVIr-GACUND C-SZTY-BOX <br /> COMPLFr1CN <br /> con,+PL.mcN <br /> SPECIAL PERMIT INFO. Ground Sudact <br /> Distance to sewer line grout <br /> Domestic well on site - ( y/ n ) <br /> If yes, location and distance <br /> Y" O <br /> C <br /> SAMPLING : _ <br /> •loroi ::^ — � <br /> _ soden -- <br /> Holding Temperature nA �&'e— <br /> Method (, n O.Q.M <br /> - = pravd Pack <br /> 1'A_i-i'J /�X . �5;. <br /> Screening, Method _ <br /> Tracking Sheet - L/ n) <br /> Y <br /> SPOILS <br /> Storage Method n(0-0 �AG MATERIALS/DEVELOPMENT <br /> Contamination Noted - (Y,/ n ) � <br /> Storage Location_ C'- _mac g Casing type a e \1C, <br /> Blank fr. Screen <br /> e <br /> Slot size 1 G <br /> GROUTING Bags cement <br /> Depth to water Buckets bentonite ^l z (,-r,, <br /> Bags sand/gravel—,r". <br /> Mix Rarios - �d,6 �6 14 z-0 Filter Pack type/size <br /> Installation Method Surge Block: - (y/3) <br /> Quantity Installed Discussed with geologist: - (y/(D) <br /> EH 29 29 Type of method <br />