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MONITORING WELL INSTALLATION REPORT <br /> Date: Z3 1 0 0 CONMUCTION <br /> Premise Address:— 2:21 Total Depth <br /> Screen Length (from) � <br /> Well No.: <br /> Filter Pack (from) 3 (to) 3!g <br /> Ins ector- Bentonite (from) --?21 (to) 'jai <br /> p Grout (from) _ <br /> Permit No.- Drilling rig type _1 <br /> Auger O.D.. Tn 7— I.D. <br /> Drilling Company-.__w 41+V_�_ Completion - Stove pipe/clu-istie box (circle one) <br /> Driller-----AkJ" casing <br /> Consultant height <br /> Geologist <br /> i, rA t-,U win t., ► <br /> AE&E-GRCUND <br /> 00kFLETCN CHRZTY_a0X <br /> SPECIAL PERMIT INFO. COMPLEMN <br /> + A& <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n t <br /> It yes, location and distance - <br /> SAMPLING <br /> Holding Temperature 6,%^ cl/­ <br /> Method <br /> 9" "Pack <br /> r <br /> Screening Method (Jl t7 <br /> — <br /> Tracking Sheet - (V n <br /> SPOILS <br /> Storage Method 0�0 MATERIALS/DEVEI,OPWNT <br /> Contamination Noted - �yn <br /> Storage Location Casing rype�__ <br /> Blank - <br /> � 5 ft <br /> GROUTING Slot Size 0-00 Screen <br /> Bags cement <br /> Depth to water r--) 3 Buckets bentonite_ ly <br /> Mix Ran'OS Bags sand/gravel Iq �Yw <br /> Installation me�0 <br /> Filter Pack type/sized, � <br /> r <br /> Quantity Installed Surge Block: - (y <br /> Type of method Discussed with 9COlOgISE: - y <br /> EH 29 29 <br />