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MONITORING WELL INSTALLATION REPORT <br /> Date: SSI CONSTRUCTION <br /> l <br /> Premise Address: `[ _�(�tw�t ftj Total Depth g� <br /> Screen Length (from) _(co)- Ste_ <br /> Well No.: M W - Filter Pack (from) 6 3 _(to) KS <br /> Bentonite (from) o, _(to)_(WIS _ <br /> Inspector. P-r en=.je% Grout` (from)_ 90 _(to)_ 60 -_1 <br /> G Drilling rig type <br /> Permit No. Z O Auger O.D. I.D.- <br /> Completion - Stove pipe/cltristie box (circle one) <br /> Drilling Company: A&%." Lt <br /> Driller• casing <br /> IF heLght <br /> Consultant <br /> Geologist -- <br /> • A-PAYE-G R CUN D <br /> 00l,�'t..�TfON Ct-RSTY-30X - <br /> C*MPtc'T1CN <br /> SPECIAL PERMIT INFO. G-ourrl Stzixa <br /> Distance to sewer line <br /> Domestic well on site y/ n) <br /> If yes, location istance - �. <br /> SAMPLING tlorR.i = c <br /> Holding Temperature <br /> Method p-�vai'acx <br /> Screening M 'r <br /> Tracki4s5cet - (y/ n) - — <br /> $`' ft. V = fi. <br /> SPOILS <br /> Storage Method S t^ MATERIALS/DEVELOPMENT <br /> Cont4mination Noted n) <br /> Storage Location to Casing type Z' PA/C_ <br /> U Blank 6 fr- Screen z0 fr <br /> Slot size ow <br /> GROLMNG Bags cement <br /> Buckets bentonites - YY " Pe,0i,45 <br /> Depth to water ^` -4 Bags sand/gravel 6- s — <br /> Mix Ratios�_ d. ot ( zo Filter Pack type/size 44 3_,:o� <br /> pstallation Method �— Surge Block: - (Y�n <br /> Quantity Installed Discussed with geolugist: - (y � <br /> Type of metliod <br /> EH 29 29 <br />