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MONITORING WELL INSTALLATION REPORT <br /> Date: o ZSR b - Will CONSTRUCTION <br /> Premise Address: 9 9 Total Depth- 1?-5 <br /> _ <br /> Screen Length (from) u sri ,(to) i 5 <br /> Well No.:. hmA1 - { ...__..,....._.. Filter Pack (from) 17, ' (to)2, <br /> Bentonite (from)._ to I (to) <br /> Inspector: Grout (from). (to) i [O <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: <br /> Completion - Stove pipe/christie box (circle one) <br /> �� <br /> Driller: casing <br /> height <br /> Consultant �Vi <br /> d <br /> Geologist <br /> ABOVE-GROUND <br /> COWLETION CHFUM-Box <br /> SPECIAL PERMIT INFO. Ground gurlCOMPLEt70N <br /> Distance to sewer line gra <br /> Domestic well on sit - (y/ n } - �_ • <br /> If yes, location distance - <br /> tt. ft. <br /> Y� 61 <br /> e <br /> SAMPLING <br /> tbttad � <br /> aac�on <br /> Holding Temperature ` <br /> Method ° _ 73"W 1� <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> - <br /> SPOILS <br /> Storage Method. , MATERIALSZ2EVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type_ `} PV C_ _ <br /> Blank j F ft. Screen /( ,ft. <br /> Slot size d2 O <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel 10 <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - ( y/0 <br /> Quantity Installed Discussed with geologist: - (y/C) <br /> Type of method <br /> EH 29 29 <br /> r ^� <br />