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MONITORING WELL INSTALLATION REPORT <br /> Date: l\1 Z°1 I oa CONSTRUCTION <br /> Premise Address. \\CA f-, (_Cr v.r;P ._Q1A.64 Total Depth_. 3 <br /> Screen Length (from) 2 (:o) �j _ <br /> Well No.: VVI W - Filter Pack (from) t ` (to)_ L� ' <br /> Bentonite (from) _141 ` (to)_ <br /> Inspector. � �� Grout (from) (to) <br /> Drilling rig type <br /> Permit No. c)O �_ � Z Auger O.D. R-z - " (.D. <br /> Completion - Stove pip cristae box 3Dircle one) <br /> Drilling Company p� <br /> Driller: casing <br /> height <br /> Consultant 'ffi= [&VNC<Y k <br /> Geologist -_ <br /> ABOVE-GROUND Ci-CRISTY-30X <br /> COAFI-ErCN COMPL.ETICN <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line graft <br /> Domestic well on - y/ n ) �� ft. <br /> If yes, locati and distance - ft- <br /> •N,. <br /> — r <br /> A <br /> SAMPLING <br /> •lora. :.: — � <br /> sacicn — <br /> Holding Temperature r =_ <br /> LY7Ya1 WCIC <br /> Method � ' s�cvv.S ,•,,. . nn_�,.�- �oo� <br /> Screening Method = <br /> Tracking Sheet - (y/ n ) _ <br /> _ <br /> ft. 7= it. <br /> SPOILS <br /> Storage MethodMATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location ay. Casing type -7- Py C <br /> Blanker ' ft. Screen_ 10 ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water_ Bags sand/gravel ^- <br /> Mix Ratios SS-�a I d,\� Filter Pack type/size I <br /> Installation Method ,ou���,,��� k•, Surge Block: - (y/ as ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br /> N, <br />