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MONITORING WELL INSTALLATION REPORT <br /> Date:_I � `�j CONSTRUCTION <br /> Premise Address: 1.1��6 Lcr�.v�ru .i, Total Depth 3 v l <br /> Screen Length (from) (to)— A_o_��� <br /> Well No.: 1V\V') -1 Z Filter Pack (from). l 3 (to)__ 3 0 <br /> Bentonite (from) i` (to) 13 <br /> Inspector. LLAeat VL L Grout <br /> (from) (to)_ ) -2.. <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. a. z <br /> Drilling Company: Pn&t�I Arni*L <br /> Completion - Stove pipe/cliristie box (circle one) <br /> Driller: casing <br /> he_ght <br /> Consultant <br /> Geologist <br /> ABOVE•GRCUND <br /> C014F1 ETION G�roC-SZTY-30 <br /> MI <br /> SPECIAL PERT INFO. N <br /> uund Sisiacs <br /> Distance to sever line grout <br /> Domestic well on site - /n) <br /> If yes, location and ranee - <br /> _ ft. <br /> ' w <br /> SAMPLING -- <br /> llorpd = c <br /> soden — <br /> Holding Temperature •:r <br /> Method — pawl pack <br /> Screening Meth _ <br /> Tracking She - (y/ n <br /> Y ) <br /> 30 ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contaminatio oted - {yl n) <br /> Storage Lo on s� � <br /> Casing type ,f <br /> Blank _ ' L<- ft. Screen S- ft. <br /> GROUTING Slot size ,Ota <br /> Bags cement <br /> Buckets bentonite <br /> Depth to water_ -V Z�I Bags sand/gravel <br /> Mix Ratios Filter Pack type/size__ <br /> Installation Method Surge Block: - Y/ ii ) <br /> Quantity Installed Discuss ith geologist: - (y/ n ) <br /> EH 29 29 T of method <br />