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*MONITORING WELL INSTALLATION REPORT <br /> Date: QQ�6 CONSTRUCTION <br /> Premise Address:Q >rD Total Depth Oib <br /> ` ,�� Screen Length (from) D, $ (m) -16 <br /> Well No.: �J Filter Pack (from)—(to)- <br /> Bentonite <br /> from) (to)Bentonite (from) (to) <br /> Inspector-! Grout (from)—(to)- <br /> Drilling <br /> from) (to)Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: 'a/�-�l`1 <br /> Driller. ��7 height casing <br /> M17 Consultant —aw-F <br /> Geologist <br /> A80VE-GROUND CHS*7Y-80X <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO, Ground Swfxt <br /> Distance to sewer line grout <br /> Domestic well on site - ( y/ n) 57 ft. <br /> If yes, location and distance - tt, <br /> tt. <br /> Gr <br /> GZ <br /> SAMPLING 1A doral _ pg <br /> soricn — T <br /> Holding Temperature gnvw pack <br /> Method = <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> —qp q6tt. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) 6 N PJ e`i� s e ti [�b <br /> Storage Location Casing type <br /> Blank ScreerdL1 - 7tk�ft. SS <br /> Slot size OX 2.6 <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel� <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />