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MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION (, <br /> Premise Address: /bot TqRN Plz Total Depth / <br /> Screen Length (from) (96 (to) <br /> Well No.: 7 /4tiD d8 Filter Pack (from) 57 (to) S <br /> Bentonite (from) Se( (to) 67 <br /> Inspector 1/cu✓*I Grout (from) $2� (to)�� <br /> Drilling rig type 207-2y <br /> Permit No. (&-)O(oy 50(n Auger O.D. E, I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: ��f �[ 1`ti 19ftbc%mEvT <br /> Driller: rcasing <br /> Consultant A(, f <br /> T height <br /> Geologist nis1)(f--� Uigic--yf'-1 <br /> ABOVE-GROUND *C=0MrPLET10N <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line 5 grout <br /> Domestic well on site - (y Cu Sy ft. <br /> If yes, location and distance - 57 tt, <br /> _ a <br /> = m <br /> 0 <br /> - m <br /> C <br /> SAMPLING NW 111"4,0D at ad _ S <br /> pa RF n — <br /> Holding Temperature = gravel pacsc <br /> Method = <br /> Screening Method , <br /> Tracking Sheet - (y/ n ) / :4. <br /> S�tt. tt. <br /> SPOILS <br /> Storage Method BIN MATERIALS/DEVELOPMENT <br /> Contamination Noted - / n ) ' <br /> Storage Location ;90&r. Casing type P UC <br /> Blank----(g9—ft- Screen--,S—ft. <br /> Slot size odfx! F <br /> GROUTING Bags cement !$L <br /> Buckets bentonite CSot <br /> Depth to water 7 Bags sand/gravel A – t6001 <br /> Mix Ratios l2 FSHGSLRS 3Syr�uut5 Filter Pack type/size Sy IUD-V13 <br /> Installation Method T-un,rE-TX/2u /)cn Fk5-Rrwrf�l� Surge Block: - (y,(D) <br /> Quantity Installed 3 (Wur-+s Discussed with geologist: - (y Al 1 <br /> Type of method <br /> EH 29 29 <br />