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MONITORING WELL INSTALLATION REPORT <br /> Date: } 1-Lji�I6 CONSTRUCTION <br /> Premise Address: 3�( !� 4 Total Depth (SO <br /> Screen Length (from) ( '!O (to) I <br /> Well No.:_ Filter Pack (from) 134 (to) 15D _ <br /> Bentonite (from) 13.l (to) fay <br /> Inspector: (�AAAe-vL Grout (from) (to) <br /> Drilling rig type <br /> Permit No, Auger O.D. I.D. <br /> Drilling Company: )cqo(jA,)1 Completion - Stove pipe/christie box (circle one) <br /> Driller:_ 1 \/ casing <br /> Consultant ��(° <br /> height <br /> Geologist ��h Hs Q (NAM T <br /> ABOVE-GROUND <br /> CONFLETION C403IM-BOX <br /> SPECIAL PERMIT INFO. Ground Surface COMPLETION <br /> Distance to sewer line grout <br /> Domestic well on site - (y _ <br /> If yes, location and d' ice - 2 ft. <br /> 112rt. _ <br /> ft. <br /> q <br /> q <br /> SAMPLING totted — c <br /> = . <br /> Holding Temperature pwdon = <br /> Method gnVW Pack <br /> Screening Method = <br /> Tracking Sheet - (y/n) <br /> SPOILS <br /> Storage Method�� MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) <br /> Storage Location_Aakj p �, <br /> � �p n.�rn .� 9nl Casing type � PVC' <br /> aq'tn 0 ' Blank I�) () ft. Screen----LO—ft. <br /> V Slot size ,n I n <br /> GROUTING Bags cement <br /> Depth to waterBuckets bentonite_) <br /> _ n7 C7 <br /> —� Bags sand/gravel <br /> Mix Ratios Filter Pack type/size 3 <br /> Installation Method 9 +,U,,�� Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> EH 29 29 Type of method <br />