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MONITORING WELL INSTALLATION REPORT <br /> Date: S I i 3 I t o CONSTRUCTION <br /> Premise Address: 5100 Pt�44c Total. Depth b <br /> Screen Length (from) S•Z (to) <br /> Well No.: 15,X) -Z 4- Filter Pack (from) (to) 6 <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) !j <br /> -7 Drilling rig type <br /> Permit No. 5 01 T Auger O.D. I.D. <br /> Completion - Stove pipe/christie-box (circle one) <br /> Drilling Company: ( �o��✓ <br /> Driller: casing <br /> height <br /> Consultant /k�coiJ <br /> —QV-f <br /> Geologist_ vG •- <br /> A80VE•GFOUND CHAIS7Y-80X <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Solace <br /> Distance to sewer line grout <br /> Domestic well on site - y/ n ) y ft. <br /> If yes, location an istance - R. <br /> ri5-tt <br /> = a <br /> _ m <br /> e <br /> 0 <br /> SAMPLING slotted <br /> aac4on s''• — <br /> Holding Temperature <;: =_ gavel Pack <br /> Method _ <br /> Screening Metilrod ;' _ <br /> Tracking eet - (y/ n) <br /> tt. <br /> SPOILS <br /> Storage Method SS o MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location OYASr'(XH..oa(ca fiko Casing type <br /> [ma ibwrei! Blank ft. Screen 6r Z <br /> Slot size iA 1 <br /> GROUTING Bags cau mt � hs 1 ale. <br /> Buckets bentonite <br /> Depth to water/ Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method a-a rn. Surge Block: - (y(�) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />