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MONITORING WELL INSTALLATION REPORT <br /> Date: �V^ 12-- <br /> CONSTRUCTION <br /> Premise Address: Total Depth_ 5-�.5 . <br /> (from)�5 <br /> Well No.: 11�UJ—/26A Screen Length —'_(to) 5$ <br /> Filter Pack (from) (to) 5 _ <br /> Inspector: �'�b9a(Kr1 Benton3' <br /> Bentonite (from) 31' (to) 3 <br /> Grout (from) Sur-rAca. (to) 31' <br /> S GS �2$ Drilling ng type_- SO/!ic <br /> Permit No. Auger O.D. I.D. <br /> Completion- Stove pipe stie box circle one) <br /> Drilling Company:_('QS�� �rillivlq 1'P <br /> Driller: NOlnaa/1 casing <br /> S <br /> Consultant height�p ' <br /> Geologist gob a 1La3Lfl w <br /> ABOVE-GROUND <br /> CONFLETION CHRZTY-BOX <br /> SPECIAL PERMIT INFO. Ground SuCOMPLE'nON <br /> Surface <br /> Distance to sewer line "Out <br /> Domestic well on site - (y/n ) <br /> If yes, location and distance - 31 (t, <br /> 3sS3, n. <br /> tt. <br /> O <br /> SAMPLING — o <br /> (lotted — c <br /> Holding Temperature <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/n) s. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) <br /> Storage Location Casing type_ Srlh- eo (VC- <br /> Blank---3- <br /> ?—ft. <br /> (/G <br /> Blank 3- <br /> ? ft. Screen Zo ft. <br /> GROUTING Slot size O.O/O <br /> Bags cement <br /> Buckets bentonite 1 <br /> Depth to water Bags sand/gravel 41 <br /> Mix Ratios- <br /> 1 /go�duoNS Filter Pack type/size n I <br /> Installation Method Surge Block: - (yo <br /> Quantity Installed 1' Discussed with geologist: - (y,t'Ila <br /> EH 29 29 Type of method_ AM- <br />