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MONITORING WELL INSTALLATION REPORT <br /> Date: II v b CONSTRUCTION <br /> J • l <br /> Premise Address: Total Depth <br /> Screen Length (from) �,2 (to) <br /> Well No.: 41 (A) 3 Filter Pack (from) s D (to) — <br /> �� Bentonite (from) Sr (to)�^ <br /> Inspector: o v �-� Grout (from) / (to) `TT <br /> _Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/cl stie bo (circle one) <br /> Drilling Company: r�/I Oi--Z c� <br /> casing <br /> Driller: � height <br /> Consultant <br /> Geologist ABOVE-GRMND <br /> . / COkiPL.cT30[d CNAiSTY-80X <br /> COMPLEnON <br /> SPECIAL PERMIT INFO.S�xtacs <br /> � proof <br /> Distance to sewer line 6 <br /> Domestic well on site - ( y/ n ) ,� ° �..:.ft- <br /> If yes, location and distance - j03 ft- <br /> — m <br /> _ o <br /> SAMPLING ° Oorad <br /> � soc9cn —_ 2 <br /> U/ ? _ ack <br /> Holding Temperature I — �7Y0q F <br /> Method — <br /> Screening Method — <br /> Tracking Sheet - ( y/ ri _ <br /> SPOILS <br /> Storage Method MATERIALS/DEVEI.OPMENT <br /> A/ <br /> Contamination Noted - (y/ n ) Casing type 3 <br /> Storage Location �l + /(C , �J l� ,--,--- <br /> Blank--2j:2 � ft. Screen 7� fr• <br /> Slot size <br /> GROUTING Bags cement <br /> / Buckets bentonite <br /> Depth to water �i��� / C�/ `L Bags sand/gravel <br /> Mix Ratios _ — Filter Pack type/size <br /> Installation Method / Surge Block: - ( y <br /> Quantity Installed y Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />