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MONITORING WELL INSTALLATION REPORT <br /> Date:_ I z 101 rp CONSTRUCTION <br /> Premise Address: 6� Total Depth S` <br /> Screen Length (from) h s (to) S <br /> Well No.:_IR1W-I g b aM IA) (� Filter Pack (fr in). 6'� (to)— <br /> Inspector: _ ►�w�n�nl„ xe te Smw( from) Z (to)_ Z (F <br /> Grout (from) —(to) <br /> p �cd Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: o.,r,�A <br /> Completion - Stove pipe/christie box�(circle one) <br /> Driller:_ 7Qnti/ casing <br /> / height <br /> Consultant 61C^A f' <br /> Geologist L$r A k jCA J yM - <br /> �r A80 -GFiWND <br /> COMPLETION CHRZTY-BOX <br /> SPECIAL PERMIT INFO. COMPLETION <br /> Ground Surface <br /> Distance to sewer line Drool <br /> Domestic well on s' . (y/n ) <br /> If yes, locatio d distance - 6 Z ft <br /> f2 Sft. ft <br /> q <br /> 9 <br /> SAMPLING = c <br /> dotted = c <br /> sac6on <br /> Holding Tempe <br /> Method = pnvalpacic <br /> Screen' g Method <br /> TryKing Sheet - (y/ n ) <br /> �S ft. <br /> SPOILS <br /> Storage Method oN nlf.Q41d• MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type Z PVC - so.v..Sdao. &w <br /> Blank 6 S ft. Screen hd ft. <br /> GROUTING <br /> Slot size <br /> Bags cement <br /> Depth to water gct 'h"""=• <br /> Mix Ratios Bags sand/gravel <br /> Filter Pack type/size <br /> Installation Method Surge Block: - (y/0>) <br /> Quantity Installed Discussed with geologist: - (y,(j�P) <br /> EH 29 29 Type of method <br />