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MONITORING WELL INSTALLATION REPORT <br /> Date: z' CONSTRUCTION <br /> Premise Address: lc2d G Total Depth �S <br /> Screen Length (from) ft-6-57(to) <br /> Well No.: LJ f 3 Filter Pack (from) 3 (to) <br /> Bentonite (from) (to) <br /> Inspector• Grout (from) (to) ate,,1, _ <br /> Drilling rig type <br /> Permit No. Auger O.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: VA [nyee _ <br /> Driller: ��n.•dc_ __ casing <br /> height <br /> Consultant L"'1 4 <br /> Geologist C—'3 <br /> Ai�vr=-GFICUND Q_Mt Y-80X <br /> COMPLETION COMPLEnON <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line gr <br /> out <br /> Domestic well on site 7ance <br /> n ) <br /> If yes, location and - . <br /> v� m <br /> • D <br /> SAMPLING alott�d Y; <br /> a*cdo n <br /> Holding Temperature <br /> Method = <br /> Screening Method <br /> Tracking Sheet n) <br /> SPOILS <br /> Storage Method JA L4 L, MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y I k <br /> Storage Location Casing type <br /> Blank b 5;-- ft. Screen 30 ft. <br /> Slot size vbj.b <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/siz <br /> Installation Method Surge Block: - (y le <br /> f <br /> Quantity Installed Discussed with geologist: - ( y Cn? <br /> Type of method <br /> EH 29 29 <br />