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-MONITORING WELL INSTALLATION REPORT <br /> Date: G/l3/dt CONSTRUCTION <br /> II <br /> Premise Address: <br /> lZ � ���{� (' e c�,V !e-c4 Total Depth , <br /> Screen Length (from) l (to)_ <br /> Well No.: A'1- U 3 Filter Pack (from) 16 (to) S l <br /> //� ��// ,, p Bentonite (from) 88 (to) 1 <br /> Inspector. IOW-11110 Grout (fro ! (to)..� <br /> Drilling ng type <br /> Permit No. Auger O.D. I.D. <br /> Completion . Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Drller: T_ casing <br /> height <br /> 7m6LIV Consultant <br /> Geologist •- <br /> ABOVEGROUND CHRMTY-80X <br /> COf.4�LETION CCMPL�TiCN <br /> SPECIAL PERMIT INFO. Ground Sl fan <br /> J_J�,,,, I �� i grout <br /> Distance to sewer line I 1 V - ` <br /> Domestic well on site - ( y/ ft. <br /> If yes, location and distance f 5 ! S ft. <br /> = o <br /> _- o <br /> SAMPLING Monad = <br /> sacicn <br /> Holding Temperature = vd <br /> Method77. = F <br /> Screening Method _ <br /> Tracking Sheet - (y/ n )_ <br /> .ft. = ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) / n �UC 5 L t5 <br /> Storage Location Casing type 7 <br /> Blank_____2 0 ft. Screen 20 ft. <br /> Slot size 6.00 <br /> GROUTING Bags cement2 <br /> Buckets bentonite <br /> Depth to water �� t t) Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - ( y/� ) <br /> Quantity Installed Discussed with geol gist: - ((y/ n ) <br /> Type of method <br /> EH 29 29 <br />