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MONITORING WELL INSTALLATION REPORT <br /> Date: /Z CONSTRUCTION <br /> / <br /> Premise Address: Gc.)( 7URNP/<E TC) Total Depth 4� <br /> Screen Length (from) 40 (to) <br /> Well No.: 0 - / 9, Filter Pack (from) (to) C,S <br /> Bentonite (from) (to) S <br /> Inspector: J'�0VKU01 Grout (from) O (to) 55 <br /> / Drilling rig type 90TFQ9 <br /> Permit No. �li4 so(p Auger O.D. T7 . I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: 41-1, Ll��/,l. �gA/uAOli4EAJ'I' <br /> Driller: n1�4teE� 5GIA - JoSE 5QA d-<VWU TT casing <br /> T height <br /> Consultant <br /> Geologist � U(�NJtejA /180VElagoUND <br /> COLFLETION VZMTY4= <br /> SPECIAL PERMIT INFO. GrourdSuriA" <br /> � groutDistance to sewer line <br /> Domestic well on site - (yACK:) $y tt. <br /> If yes, location and distance - 57 tt, <br /> P <br /> m <br /> C <br /> SAMPLINGN n t1OROF� u, <br /> Holding Temperature _ pra pack <br /> Method <br /> Screening Method : <br /> Tracking Sheet - (y/ n) <br /> �t_tt. _ (v� tt, <br /> SPOILS <br /> Storage Method S 1 N MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n) <br /> Storage Location Parcta6 .1.0T Casing type �V <br /> Blank Screen ft. <br /> Slot size wrrQ�o fbaf <br /> GROUTING Bags cement /2 <br /> Buckets bentonite / 5o us', <br /> Depth to water 17 Bags sand/gravel F So " ZCO AS's <br /> Mix Ratios Filter Pack type/size 03 Squ D <br /> Installation Method T2iwrmrF — PawrPEi Surge Block: - ( y/E5� <br /> Quantity Installed -1�Ruw g Discussed with geologist: (y A ) <br /> Type of method <br /> EH 29 29 <br />