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MONITORING WELL INSTALLATION REPORT <br /> Date:f Z CONSTRUCTION <br /> Premise Address: /&C)t TURu pt4 kj Total Depth la� <br /> Screen Length (from)— (po (to) Cos <br /> Well No.: C( Filter Pack (from) .1 (to) G S <br /> Bentonite (from) 5v_(to) S <br /> Inspector: 0✓�fPuwl Grout (from)_ ygkE (to) SX <br /> Drilling rig type GPEmoTC oK' ass <br /> Permit No. 5Qo0(,y Say Auger O.D. I.D. <br /> Completion- Stove pipe/christie box (circle one) <br /> Drilling Company: Al L W dhL f;An,DyUWX+117 <br /> Driller: �V�� SLfi casing <br /> height <br /> Consultant 4L� <br /> Iff T <br /> Geologist 17/4nrt(iL 11r![�t,gcU/7 _ T <br /> ABOVEGROUND CHROTY-BOX <br /> CONFLETION COMP[-ETION <br /> SPECIAL PERMIT INFO. Ground Surf <br /> 7 grout <br /> Distance to sewer line1/0 � <br /> Domestic well on site - (y/ r�1 ft. <br /> If yes, location and distance - 67 ft. <br /> tt. <br /> = a <br /> = m <br /> P <br /> - 0 <br /> - C <br /> - O <br /> SAMPLING slatted = g` <br /> No u6 section — <br /> Holding Temperature <br /> Method ' _ <br /> Screening Method = <br /> Tracking Sheet - (y/ n ) <br /> tt. <br /> SPOILS <br /> Storage Method J-rU5 own-, MATERIALS/DEVELOPMENT <br /> Contamination Noted - y n ) Casing a Q��. <br /> Storage Location �� Blank 0-40 ft. Screen_(,b-C.S R• <br /> Slot size MPR ?6&R - <br /> GROUTING Bags cement r` <br /> Buckets bentonite -�-Met 'R�R4 � Daur <br /> Depth to water ti Bags sand/gravel _ a /et <br /> Mix Ratios_ (mLA5 ;o raGcaUf Filter Pack type/size -- A9 Sd1Na <br /> Installation Methor Surge Block: - (y Afa)) <br /> Quantity Installed 2 nR •-s Discussed with geologist: - (y/ n� <br /> Type of method <br /> EH 29 29 <br />