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MONITORING WELL INSTALLATION REPORT <br /> Date:`�/lJ- . <br /> CONSTRUCTION <br /> Premise Address: <br /> Total Depth 3 T <br /> Well No.:_ �kJG�17 Screen Length (from)' 2 (to) <br /> Filter Pack (from) 2 (to) <br /> Inspector: _ J•`f°�(A'lbt� Bentonite (from)_ l9 4T- (to) zi <br /> Grout (from) O (to) !2{T <br /> Permit No. Drilling rig type �d Pacwe„ <br /> Auger O.D. " LD. <br /> Drilling Company: 6"6 a Completion tove pie •'stie box (circle <br /> Driller:_ �`l"Q�s s-r PI3d�C' - 22 <br /> T casing <br /> Consultant height <br /> Geologist�vS-R�r 2 ��� •J ♦ T <br /> ABOVE-GROUND T <br /> Ccwt ETION CHRZ Y-BOX <br /> SPECIAL PERMIT INFO, COMPLETION <br /> Ground Surface <br /> Distance to sewer line <br /> Domestic well on site - (Y/n) grout <br /> 19 <br /> If yes, location and distance - - ft <br /> 2A ft ft. <br /> SAMPLING <br /> dotted — c <br /> Holding Temperature 1°`70n — <br /> ;r; <br /> Method = <br /> P ivsl Pack <br /> Screening Method =x — •' <br /> Tracking Sheet - (y/n) <br /> SPOILS $ ft <br /> Storage Method <br /> MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) - <br /> Storage Location ` <br /> Casing type eJ Scan. 04D Q VG <br /> Blank_ '3 1 ft. Screen_ , g. <br /> GROUTING Slot size O.0 2p <br /> Bags cement <br /> Depth to water Buckets bentonite <br /> Mix Ratios Bags sand/gravel_ So <br /> Installation Method Filter Pack type/sizenr <br /> _ 4k 3 SA4 <br /> Quantity Installed --------- Svrge-Block:_(-Y./na <br /> Discussed with geologist: - (y/n) <br /> EH 29 29 Type of method <br />