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MONITORING WELL INSTALLATION REPORT <br /> Date: <br /> CONSTRUCTION <br /> Premise Address:_ �{n �_- � 5 1_ <br /> J- Total Depth 1 �� <br /> Well No.: JA Screen Length <br /> Filter Pack (from)_ n'i (to) t I D <br /> Inspector: ~ r" Bentonite (from)-q —(to)--b2` Grout <br /> (from)— (to) <br /> Permit No. 059 L Drilling rig type <br /> Auger O.D. I.D. <br /> Drilling Company: Completion - Stove pipe/christie box (cir <br /> Driller:_ Lr <br /> casing <br /> Consultant -` height <br /> Geologist��j �r <br /> ABOVE-GROUND <br /> --_ COMPLETION CHFIIM43OX <br /> SPECIAL PERMIT INFO. - - --- <br /> ----COMPIETIDN--_ _.. <br /> C3rouund Surface 7 <br /> Distance to sewer line <br /> Domestic well on site - ( Qf0"f <br /> If yes, location and ce - C�� - ft <br /> . .ft. ft. <br /> = m <br /> SAMPLING = <br /> elottad - c <br /> Holding Temperature Yt wcJon <br /> Method�._(nd Gravel pack <br /> Screening Method <br /> Tracking Sheet - 0/ n ) <br /> ft. <br /> SPOILS 00 ft. <br /> StgCon a m Method S L1 N. <br /> Contamination <br /> Noted - / n ) -MATERIALS/DEVELOPMENT <br /> Storage Location <br /> Casing type cal !IQ 2 pVC <br /> Blank�ft. Screen G R, <br /> GROUTING Slot size__- ,c z <br /> Bags cement <br /> Depth to waterN(�p ' Buckets bentonite <br /> _ l <br /> Mix Ratios Bagssand/gravel <br /> Installation Method Filter Pack type/size A (.ct._-c ._ �f <br /> Quantity Installed p� Surge Block: - Q/ n) <br /> - YY Discussed with geologist: -©/ n ) <br /> EH 29 29 Type of method <br />