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MONITORING WELL INSTALLATION REPORT <br /> Date: 1 2. ' 1 a CONSTRUCTION <br /> Premise Address: 10 '4 -_Ss Loo� S-. (c04 I Total Depth 6 a <br /> ( Screen Length (from) '-L a (to) ' <br /> Well No.:JM e, o�fit Filter Pack (from) 3 (to) 6 C) <br /> Bentonite (from) 3 S (to) 3 - ' <br /> Inspector: Grout (from) (to) 3 T ' <br /> Drilling rig type <br /> Permit No. Auger O.D. •z I.D. <br /> Completion - Stove pipe/ stie box (circle one) <br /> Drilling Company: SL' � <br /> Driller: JZ , casing <br /> Consultant f.�C�i!E7 <br /> T height <br /> Geologist k o vj IM c Le_t 66 e T •- <br /> ABOVE-GROUND <br /> COMPLETION CHS STY-80X <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line 2 grout <br /> Domestic well on site - (y/(�P <br /> If yes, location and distance - qq <br /> c <br /> SAMPLING = <br /> stoned <br /> sedan — <br /> Holding Temperature 0'U a a�-f_ t Clkpack <br /> Method (T.o.•,7 4-tnk')4 V'eIS-c' jex e,I„t"-t _ gm%*iW <br /> Screening Method N:t 'C <br /> Tracking Sheet - (Y/ n) " <br /> 1,C R. = fL <br /> SPOILS <br /> Storage Method S c�N� d�r�w MATERIALS/DEVELOPMENT <br /> Contamination Noted"- (©/ n ) <br /> Storage Location ov. s r*-le- Casing type A {�V <br /> Blank �I b ft. Screen o ft. <br /> Slot size .02-0 <br /> GROUTING Bags cement <br /> Buckets bentonite-3/,4hag <br /> Depth to water --+ Bags sand/gravel S• loo tt $o.� <br /> Mix Ratios c Y-f Filter Pack type/size ;jj. <br /> Installation Metho *W6004" . �s,,,� Surge Block: - (y/0) <br /> Quantity Installed 1\C' Discussed with geologist: - qy)/ n) <br /> Type of method <br /> EH 29 29 <br />