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MONITORING WELL INSTALLATION REPORT <br /> Date: F> 12-b I 10c) CONSTRUCTION <br /> Premise Address: 514 Z A) >>c,� 9G1 Total Depth <br /> Screen Length (from) q CT (to) <br /> Well No.: IM (n1 - Filter Pack (from) (to) 4- <br /> Bentonite (from) (to)_ '-( S{' <br /> Inspector: e-c1 Grout (from) (to)_ yr,' <br /> Drilling rig type <br /> Permit No. 0 O Z- Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: 9r height casinq <br /> Consultant /4-&-� � ' <br /> Geologist L-V (.r-f 4LA -qw, <br /> AI;CV -GROUND Ci iA m-aOX <br /> OOWLEf10N CompuncN <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line <br /> Grout <br /> Domestic well on site - (y/ n ) ' ' h ft. <br /> If yes, location and distance - ft. <br /> SAMPLING T = <br /> sockcn _ <br /> Holding Temperature n <br /> Method Pack <br /> r _ �"1Y9� <br /> Screening Method <br /> Tracking Sheet - r/ n ) 7.. <br /> ft. = ft. <br /> SPOILS <br /> Storage Method_ enn MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n <br /> Storage Location m.. ,nA .C-s Casing type a P V <br /> Blank Loc( ft. Screen_ 9,b ft. <br /> Slot size , C'> 10 <br /> GROUTING Bags cement ni 15 <br /> _ Buckets bentonite 6ra,& <br /> Depth to water 'v S Bags sand/gravel 5 Ij <br /> Mix Ratios , o,e�(_` n Filter Pack type/size a 1 z <br /> Installation Method -Uj Surge Block: - (y/(!b) <br /> Quantity Installed_ i '.a JP00= IA Discussed with geologist: - (y/(D <br /> 1 <br /> Type of method <br /> EH 29 29 <br /> ." 1 <br />