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0 0 <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: LL(�"Q bl CONSTRUCTION <br /> Premise Address:K?lqg2 M/�/C b l�`� Total Depth aq <br /> Well No.: l « (a Screen Length (from) ( (to) to <br /> Filter Pack (from) (01 • (to) oc• <br /> B o/ Bentonite (from) (OO'S' (to) '11. <br /> Inspector: `d Q w Grout (fro �(to) <br /> Permit No. el OO q `1)y Drilling rig S <br /> Auger O.D. Art1l" I.D. <br /> Drilling Company; <br /> Completion - Stove pipe/christie box (circle one) <br /> C(">P° (4 , <br /> Driller:�5 - casing <br /> / height <br /> Consultan(d" <br /> Geologist `�Wv A4 <br /> ABOVE-GROUND <br /> COMPLETION CHRfM-BOX <br /> SPECIAL PERMIT INFO. Ground Surface <br /> COMPLETION <br /> Distance to sewer line proal <br /> Domestic well on site - (y/n ) <br /> If yes, location and distance - n- <br /> Cv� S n. <br /> 1 - <br /> _ m <br /> SAMPLING = <br /> dotted — c <br /> Holding Temperature do ` saction <br /> Method pack <br /> Screening Method <br /> Tracking Sheet - (y/n) <br /> 1,3 •s n. = n <br /> SPOILS Tj, /Zi <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) L <br /> Storage Location Casing type "ru G S[' 1 b <br /> Blank l6 i •5 ft. Screen 2.d ft. <br /> Slot size O.olo <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water it) 13 < Bags sand/gravel I L <br /> Mix Ratios AL Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n) <br /> Type of method <br /> EH 29 29 <br />