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MONITORING WELL INSTALLATION REPORT <br /> Date: O CONSTRUCTION <br /> ` nn / <br /> Premise Address:_ `L�8 I 4"Cti� Total Depth 3 <br /> J Screen Length (from) '�U (to) D <br /> Well No.: ✓�'/ !iv Filter Pack (from) 36 _(to) <br /> Bentonite (from} (to) <br /> Inspector: 6 Grout (from) (to)� <br /> / Drilling rig type <br /> Permit No.y 7� -2-22r t�2Auger O.D. 1' <br /> Completion - Stove pipe c iristie ho (circle one) <br /> Drilling Company: � t/��C`��� <br /> Driller casing <br /> he; <br /> Consultant <br /> Geologist l � T <br /> ABOVE-GRCUND CKszlry-80X <br /> OO MP LETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface 5, <br /> Distance to sewer line- <br /> Domestic well on site (y/ n ) Q <br /> If yes, location and distance - j �^ ft.ft. <br /> ue � �tt. <br /> (/ <br /> SAMPLING <br /> soc7cn _ <br /> Holding Temperature VIY01 Pack <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n ) _ <br /> fi. a ft. <br /> SPOILS <br /> Storage Method_hA.��� �a� MATERIALS/DEVEI.OPMENT <br /> Contamination Noted - ( y/ n ) <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water � Bags sand/gravel <br /> Mix Ratios /P.-/ Filter Pack type/size <br /> Installation Method_ Surge Block: - (y/ ii ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />