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MONITORING WELL INSTALLATION REPORT <br /> Date: 1�_1-t 3 D CONSTRUCTION <br /> Premise Address: CLD � N:jrJ_r1_ Total Depth_ t�-�� Z 33 7-b <br /> L Screen Length (from} Z Z,,6 _(to)----Z-N-A� <br /> Well No,: IM JA I- Filter Pack (from) <br /> Bentonite (from)_ <br /> Inspector: Grout (from) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company:_ V Completion- Stove pipe/christie box (circle one) <br /> � �,��n .., — . <br /> Driller casing <br /> height <br /> Consultant ( i T <br /> Geologist T <br /> ABOVE-GROUND CI�ItSTY-80X <br /> COLETiON COMPLETION <br /> SPECIAL PERMIT INFO. Ground Suixas �,� � <br /> Distance to sewer line s?; <br /> Domestic well on site - <br /> If yes, location and dista e - t n• <br /> ZC ft. z Lz It. <br /> vq <br /> a•� q <br /> SAMPLING y= _ <br /> slcttod — <br /> sac�on <br /> Holding Temperature — <br /> Method = qr"`w Pack <br /> Screening Method — - <br /> Tracking Sheet - (y/ n) ' <br /> SPOILS <br /> Storage Method-----L-'l LA MATERIALS/DEVELOPMENT <br /> Contamination Noted - {y/ n ) <br /> Storage Location .Slh 5[� _ _ Casing type <br /> Blank <br /> AS ft. Screen Pew ft. <br /> Slot size 0209 <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/graveI <br /> Mix Ratios Filter Pack type/size_ <br /> Installation Method Surge Block: - ( y AV <br /> Quantity Installed Discussed with geologist: - (y/(n) <br /> Type of method <br /> EH 29 29 <br />