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MONITORING WELL INSTALLATION REPORT <br /> Date: `` 12 — ;-0 1.3 CONSTRUCTION <br /> Premise Address: 68-3 Total Depth % Z <br /> Screen Length (from)• "7 a <br /> Well No.: 1\1.5C Filtet Pack (from) 7'2 (to) <br /> Bentonite' (from) 22�(to)-3S';— <br /> Inspector: �)�sj��)y� y ��,. u,,l Grout (from) SS <br /> Permit No. (c / ( Drilling ng type C-A4 1 `l 5 if S <br /> Auger O.D. I.D. 1-1 <br /> Completion tove pipe' chnstie box (circle one) <br /> Drilling Company:_ Cc, <br /> Driller: L` (` ' S 4 �c Z c" <br /> casing <br /> height <br /> Consultant <br /> Geologist <br /> JSBO VE-G R CUND <br /> cowLmON C*tRz-ry-B0x <br /> SPECIAL PERMIT INFO. COMPL.E71ON <br /> C3round Surixa <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n) �� <br /> If yes, Iocation and distance - 9d . ft. <br /> • y 2 ft. ft. <br /> h^ o <br /> SAMPLING = o <br /> &4c=on = <br /> Holding Temperature = <br /> Method — v2vs?Pack <br /> Screening Method <br /> Tracking Sheet - (y/n) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) <br /> Storage Location Casing type S G 14 JYC <br /> Blank ft. Screen 3h ft. <br /> Slot size C, L 2-G <br /> GROUTING Bags cement <br /> Buckets bentonite_ <br /> Depth to water 5 Bags sand/gravel <br /> Mix Ratios Filter Pack type/size 3 �c�r > 4,),Tl- S'enl/ <br /> Installation Method—LL, om,,, i, ; - �, _!Lj , -.-----Surge Block:_(/n_) _ <br /> Quantity Installed Discussed with geologist: - (y/ n) <br /> EH 29 29 Type of method <br />