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MONITORING WELL INSTALLATION REPORT- <br /> Date: <br /> EPORTDate: CONSTRUCTION <br /> Premise Address: (,e loo Total Depth <br /> Well No.:_ l�� `� L, Screen Length (from)' '7-) (to)�� <br /> Filter Pack (from) 7 <br /> Bentonite' t <br /> Inspector: _ �• .y Grout <br /> (from) <br /> Permit No. 6613 -7 Drilling rig type C' E <br /> Auger O.D. I.D. <br /> Completion ovepipe/ch istie box (circle one) <br /> Drilling Company:_ C c� S <br /> Driller: >ec << e'` kcasing <br /> height <br /> Consultants <br /> Geologistl, tr/r <br /> ABOVE-68CUND C}iFilS7Y 80X <br /> CO w LETIO N <br /> SPECIAL PERMIT INFO. COMPL.EnON <br /> G=r)d Surface <br /> Distance to sewer line graft <br /> Domestic well on site - (y/n) I <br /> If yes, location and distance <br /> ft. <br /> SAMPLING = o <br /> ' _ •(octad _— c <br /> Holding Temperature <br /> Method = plc <br /> Screening Method = <br /> Tracking Sheet - (y/n) <br /> ?Z <br /> ft. 7� fl. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) <br /> Storage Location Casing type SL lc `1C �G C <br /> Blank '17 ft. Screen (i ft- <br /> Slot size 'I C�C <br /> GROLTIING Bags cement (a q7 Las <br /> Buckets bentonite_ <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size C c rn Qx la"I) <br /> Installation MethodC <br /> ______Surge_Block:= /n_) <br /> Quantity InstalledDiscussed with geologist: - (y/ n) <br /> EH 29 29 Type of method <br />