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MONITORING WELL INSTALLATION REPOmI <br /> Date: ` -�// Zfn ZC2�� CONSTRUCTION <br /> Premise Address: 2-V7 E. Owl✓ Total Depth <br /> Screen Length (from) (to) S <br /> Well No.: /�!.✓(S Filter Pack (from) (to) <br /> Bentonite (from)=1—(to) <br /> Inspector: Grout (from) (to) a <br /> Drilling rib typed 5 <br /> Permit No. Y Z Auger O.D. I.D. <br /> Drilling <br /> ��Comp/any: N/��d// Completion - Stove pipe/christie box (circle one) <br /> Driller: casing <br /> height <br /> Consultants T <br /> Geologist ' /180VE-GFiWND <br /> N <br /> COMPLETION TIO <br /> COMPlFTION <br /> SPECIAL PERMIT INFO. Ground Surface +�� <br /> �� grout <br /> Distance to sewer line �' <br /> RE <br /> Domestic well on site - (y l� `ll - ft. <br /> If yes, location and distance - ft. <br /> _ a <br /> = m <br /> 0 <br /> C <br /> SAMPLING etotted <br /> wc5an <br /> Holding Temperature = - 9n+I Pack <br /> Method =_ <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> SPOILS <br /> r MATERIALS/DEVELOPMENT <br /> Storage Method <br /> Contamination Noted - (y/ n ) �D 2 " �� 40 <br /> ✓e <br /> Storage Location Casing type - <br /> Blank ft. Screen lO ft. <br /> Slot size o28 <br /> GROUTING Bags cement <br /> Buckets bentonite / GG <br /> SD Bags sand/gravel >Sfy <br /> Depth to water — <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: -Un ) <br /> Quantity Installed Discussed with geologist: - ( y n) <br /> Type of method <br /> EH 29 29 <br /> lP-Z6-61 ''- 75 <br />