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MONITORING WELL INSTALLATION REPORT <br /> Date: �6 I t '( 1 I b CONSTRUCTION <br /> Premise Address: Total Depth S6 <br /> Screen Length (from) -4 :5- ' (to) .SO' <br /> Well No.: VV\(NJ 5 + Filter Pack (from) 33 (to) 35 <br /> Bentonite (from) 3 ( (to) 3 31 <br /> Inspector: I, ,-A�. Grout (from) to) 31 <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: t�nr n rr <br /> Driller: casing <br /> Consultant r �+il an _ <br /> TffLT height <br /> Geologist \in 6")PAn4' <br /> ABOVE-GROUND C7iAI5TY-BOX <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surfs <br /> Distance to sewer line grout <br /> Domestic well on site - /n ) 1 .3, ft <br /> If yes, location an istance - <br /> n. <br /> q � 9 <br /> q <br /> C <br /> O <br /> SAMPLING donnd _ S <br /> iac 'on <br /> Holding Temper = P <br /> M <br /> Screening Method VtW (LAArui.:;� ; <br /> Trarldag 6kaeeL(�t/n ) <br /> _ So tt — tt. <br /> SPOILS !/ <br /> Storage Method SPS 0 `�`' MATERIALS/DEVELOPMENT <br /> Contamination Noted - //CF) <br /> Storage Locati Casing type Z P VG <br /> Blank f 3 fr. Screenn---- <br /> J-S' ft. <br /> Slot size .010 <br /> GROIPCING Bags cemen <br /> Buckets bentonite `/-s. n n <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size Z l Z <br /> Installation Method Surge Block: - ( y/(ff-j <br /> Quantity Installedr5 wf�m, 3 Discussed with geologist: - (y/0 <br /> ) <br /> Type of method <br /> EH 29 29 <br />