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MONITORING WELL INSTALLATION REPORT <br /> Date: k t l 3 y 00 CONSTRUCTION <br /> Premise Address: l (XnA&X' Total Depth Z`1f 1 <br /> �!� Screen Length (from) i- 3 (to) _ <br /> Well No.: Filter Pack (from) �T_jo) 2-1 <br /> Bentonite (from) L(to) kj <br /> Inspector. moo" Grout (from) -e- ;to) 9,.•,__ <br /> Drilling rig type <br /> Permit No. O Z- Auger O.D. t A t%. I.D._ <br /> Completion - Stove pipe/clu-istie box (circle one) <br /> Drilling Company: �. c�L <br /> Driller: � l casing <br /> + he_ght <br /> Consultant O (ln t,,c4 r-:; `ems <br /> Geologist_ /�nn�i�1'olQ V1nfi� <br /> • ABOVE-GRMND C}-A:STY�OX <br /> 00NVLFrCN GCMPt-=7CN <br /> SPECIAL PERMIT INFO. G=rd Surface <br /> Distance to sewer line Grccrt <br /> Domesric well o e - ( y/ n ) 3,�Z ft. <br /> If yes, locati and distance - <br /> v � O <br /> _ � M <br /> SAMPLING = o <br /> Moroi <br /> Holding Temf erature <br /> Method (J Bio r L,`�(S`G✓�24(P?� _ pIvd Pack <br /> Screening Method <br /> thod <br /> Tracking Sheet - ( y/ n ) <br /> � ..tt. Vti. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y f, <br /> Storage Location pyo Casing type `� ?y . <br /> Blank ft- Screen_ 1< ft. <br /> Slot size • o <br /> GROUTING Bags cement 5 r�oi�4-t o, .cam• <br /> Buckets bentonite L-af E,A- <br /> Depth to water_ Bags sand/gravel <br /> Mix Ratios Filter Pack type/size 2, 1 <br /> Installation Method ' Surge Block: - (y/2?) <br /> Quantity Discussed with geologist: - ( y,�) <br /> EH 29 29 Type of method <br /> r <br />