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MONITORING WELL INSTALLATION REPORT <br /> Date.. L�t <br /> CONS_ TRS N <br /> Premise Address: 17G')g <br /> �,, — Total Depth � r <br /> Well No.: l2j(�� — N Screen Length (from) a <br /> Filter Pack (from) 50 (t°)—�—_ <br /> Inspector: v ; 6 Bentonite (C0) <br /> (hom) (to) <br /> Grout (from) <br /> Permit No. S/Z ZG �D L Drilling rig typel <br /> _ (to) <br /> La, �i „ <br /> Auger O.D. I.D. <br /> Drilling Company; Completion - /cltristie box (Cir— cl�— <br /> Driller: <br /> casing <br /> Consultant � height <br /> Geologist <br /> ABOVE-GACUND <br /> SPECIAL PERMIT INFO. CONFLET CNAISTY-aox <br /> Ground Saixs CCM <br /> PLETICN <br /> Distance to sewer line <br /> Domestic well on site - ( grout <br /> If yes, location and dista c <br /> ft. <br /> �o Z4 <br /> SAMPLINGQ� uJc+o rf C ( <br /> -te ewl. iCi �IoCed = c <br /> Holding Temperature S��[/ sucicn = 3 <br /> Method_ <br /> Screening Method - = ti"vdPack <br /> Tracking Sheet • ( y/ n ) <br /> S� ft. — --ft. <br /> SPOILS <br /> Storage Method_ IZ,(- MATERIALS/DEVELOPMENT <br /> Contamination Noted . (y )7 r� <br /> Storage Location Casing type_ S4 yO <br /> Blank __ft. Screen h, <br /> GROUTING Slot size <br /> Bags cement---:Z 6 <br /> Depth to water Buckets bentonite_ / <br /> Mix Ratios --7— Bags sand/gravel <br /> Installation Method Filter Pack type/size <br /> Quantity Installed Z o <br /> / Surge Block: - ( y/dj-�3 <br /> Discussed with geologist: - (y/ n ) <br /> EH 29 29 Type of method <br />