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MONITORING WELL INSTALLATION REPORT <br /> �� ��� <br /> Date:TT ���-�I �/ � CONSTRUCTION � <br /> Premise Address: aw ) Total Depth <br /> i i,b Screen Length (from) 5 (to)_ � <br /> Well No.: S Sol 1 _ tiJ(�S Filter Pack (from) <br /> Bentonite (from) <br /> Inspector: R Grout (from) (to)� <br /> Drilling rig type i <br /> Permit No. Auger O.D. '✓ -! ,D. l <br /> Completion- Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller:- casing <br /> height <br /> Consultant 11 <br /> Geologist P� � �'$ CO2 V �23 <br /> ABOVE-GROUND C#iAISTY-80X <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surfw* .� <br /> j` U <br /> Distance to sewer line e., proof <br /> Domestic well on site - (y n ) ✓" <br /> If yes, location and distance - <br /> .Yr <br /> SAMPLING = <br /> •lotwd <br /> sacton ': <br /> Holding T perature T �/ <br /> v. <br /> Method_ 1 Pack <br /> Screening Method `k <br /> Tracking Sheetn ) ` — <br /> 01) <br /> :: <br /> SPOILS ` <br /> S <br /> Storage Method ,c Ori,` SA MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n <br /> Storage Location� � 19"04;( Casing type PJ6 <br /> Blank ' _ft. Sc en <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water_ , l�' q 65 Bags sand/gravel <br /> Mix RatiosJ1 0 Filter Pack type/size . -, c�,M-- <br /> Installation Method Surge Block: - (y/n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />