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MONITORING WELL INSTALLATION REPORT <br /> Date: 12.1 b-6 CONSTRUCTION <br /> Premise Address: 19 W- 5 '-r Tf ' S 41'--nd'-- Total Depth <br /> Screen Length (from) I o _(to)_z S <br /> Well No.: M to's I - 3 Filter Pack (from) JK' _(to) LS�� <br /> Bentonite (from) f- (to) TS <br /> Inspector. Grout (from) Rf (to) 6 <br /> Dn'Iling rig type <br /> Permit No. 6 I Auger O.D. <br /> Completion-Stove pipe/christie box (circle one) <br /> Drilling Company VQI'L -�ify I <br /> Dca.S ung <br /> nUe- <br /> height <br /> IT V <br /> Consultant �� � T <br /> Geologist Cin <br /> 1l3CYS-uRCt.MD :�iS�Y-3CX <br /> 0C P;rTAN <br /> SPECIAL PER-W-1 INFO. Gr=-4 Sutacs <br /> Distance to sewer line <br /> Domestic well on site - ( n) <br /> If yes, location and ce - - _;L <br /> a <br /> _ o <br /> SANTUNG slOwd --- <br /> sacra = __ <br /> Holding Tempe-a=e Fr.. _ gm+a pwx <br /> Method Y3%�o�h <br /> Screening Method p i %D <br /> Tracking Sheet -0/n) <br /> .L ♦ = _ ♦ tL <br /> SPOILS <br /> Storage MethodMATERIALS/DEVELOPMENT <br /> Contamination Noted - ©/ n ) Z "pv C <br /> Storage Location Casing type <br /> Blank l O fr. Screen I t ft- <br /> Slot size t O'er <br /> GROUTING Bags cement 3 - <br /> Buckets bentonite A=Z=— <br /> Depth to wate_- Bags sand/gravel <br /> Mia Ratios Filter Pack type/size <br /> Installation Method Surge Block - (y/�n ) <br /> Quantity Installed Discussed with geologist: - (y tn> <br /> Type of method <br /> EH 29 29 <br /> 'i --N <br />