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MONITORING WELL INSTALLATION REPORT <br /> Date: 4 O CONSTRUCTION a <br /> Premise Address:����ti�n�c Total Depth_ 2 I Sr 1 <br /> Screen Length (from) 9 ,s (to)_ <br /> Well No.:���,c) - ) ) Filter Pack (from) <br /> Bentonite (from)_ h- S- (to)__ _ <br /> Inspector. — ,,,�IV- <br /> Grout (from)_ (to) 6 S <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. _ <br /> Drilling Company: lri�ebCompletion - Stove pipe/ x (circle one) <br /> Driller: casing <br /> height <br /> Consultant•' gyp' q <br /> Geologist M <br /> ABOVE-GACUND <br /> CONFLErICN C-(RM-Y-30X <br /> SPECIAL PERMIT INFO. COMPLEnCN <br /> Ground Surface <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - 'S ft. <br /> r <br /> SAMPLING o <br /> ilOrrai :. _— c <br /> soc7cn 4 <br /> Holding Temperature <br /> Method 6"L\c,n-, „ Q op, = gnvd pacts <br /> Screening Method <br /> Tracking Sheet <br /> n <br /> —,;22--)ft. <br /> SPOILS <br /> Storage Method A V\L4-- MATERIALS/DEVEI.OPMENT <br /> Contamination Noted <br /> Storage Location 0,1 $� Casing type <br /> Blank • ti ft. Screen_ gip' ft, <br /> Slot size_ .020 <br /> GROUTING Bags cement <br /> Buckets bentonite Vz &v—.- <br /> Mix Ratios <br /> Depth to water �` Z Z- Bags sand/gravel_ 3 <br /> Installation Method Filter Pack type/size <br /> nr,,,.,.�_ Surge Block: - (y/ n <br /> Quantity Installed Discussed with geologist: - (y/ ng <br /> EH 29 29 Type of method <br /> v <br />