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MONITORING WELL INSTALLATION REPOm <br /> / y <br /> Date: /"Ol/ //o, Z_�ST� CONSTRUCTION <br /> Premise Address: 54*4Z44C Total Depth U <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) /• <br /> Inspector: Grout (from) /- (to) <br /> c� Drilling rig type t <br /> Permit No. OyC �� Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling <br /> Company: <br /> Driller: f casing <br /> height <br /> Consultant <br /> Geologist 1� • J ��-•K 311 <br /> T <br /> ABOVE-GROUND <br /> COMPLETION CtiAlSi1 80X <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line grout <br /> Domestic well on site - ( y 4 y ft <br /> If yes, location and distance - f Y6 tt <br /> a <br /> SAMPLING �Iotted = c <br /> e sac on _ <br /> Holding TemperaturegmyW <br /> L <br /> Method Cfi--G = P <br /> ack <br /> Screening Method <br /> Pr; — <br /> Tracking Sheet - C y/ n ) /V <br /> n. n. <br /> SPOILS <br /> Storage Method S~J ( 4 MATERIALS/DEVELOPMENT <br /> Contamination Noted - C y n 7b GV �N 1 Ale Storage Location d -� �r� Casing type 7U l <br /> $p{�, Blank_ ft. Screen S <br /> Slot size <br /> GROUTING Bags cement to <br /> Buckets bentonite <br /> Depth to wat Bags sand/gravel11�3 <br /> Mix Ratios O f U �— Filter Pack type/size .4 <br /> Installation Method yFi< J 7ve Surge Block: - (y n , <br /> Quantity InstalledDiscussed with geo st: - (y <br /> ¢w Type of method <br /> EH 29 29 <br />