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TvIONITORING WELL INSTALLATION REPORT <br /> Date: ` ( CONSTRUCTION <br /> Premise Address: �`� 7�e6� Gvt Total Depth /00 <br /> Screen Length (from) l (to) <br /> Well No.: KiW jf Filter Pack (from)6(to) 3 <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) O (to) <br /> Drilling rig type 75 <br /> Permit No. OU Z� Auger O.D. f I.D. <br /> /� Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: Gf/ <br /> Driller: 1�eoe f- z casing <br /> height <br /> Consultant ^� <br /> Geologist <br /> ABOVE-GRCUND <br /> COAFLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line otot71 <br /> Domestic well on site - (y F6 <br /> tt• <br /> If yes, location and distance - <br /> 9S tt. "• <br /> = o <br /> m <br /> SAMPLING slotted <br /> axyon —_ <br /> Holding Temperature = va„d Pack <br /> Method = <br /> Screening Method =_ <br /> Tracking Sheet - (y/ n ) <br /> L) <br /> SPOILS <br /> Storage Method S MATERIALS/DEVELOPMENT <br /> Contamination Note - (Vn ) , / q rr /JvLp <br /> Storage Location Z9L ' Casing type <br /> Blank ft. Screen_—.5- ft. <br /> Slot size -02D <br /> GROUTING Bags cement <br /> p Buckets bentonite <br /> Depth to water /r Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y n <br /> Quantity Installed Discussed with geologist: - (y <br /> Type of method <br /> EH 29 29 <br /> �'/9-0/ �uu/ <br />