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MONITORING WELL INSTALLATION REPORT <br /> Date: <br /> CONSTRUCTION <br /> Premise Address: ?.G 93 3 NA A/SEN Rd Total Depth <br /> Well No.: MA.)- 'TAI Screen Length (from) //ILI (to) � <br /> Filter Pack (from) 16Z (to) /f <br /> Inspector: `� yv/q/rawl Bentonite (from) CP 13 (to) -Acle <br /> Grout (from) 4 (to) — <br /> Permit No. Drilling rig type_ -y <br /> Auger O.D. fa I.D. <br /> Drilling Company:_ V W a< <br /> Completion - Stove pipe/christie box (circle <br /> Driller: F/ZI[iNt' <br /> W <br /> casing <br /> Consultant <br /> Musep oll" height <br /> Geologist S0- T <br /> ABOVE-GROUND T <br /> COMPLETION CNRIM-BOX <br /> SPECIAL PERMIT INFO COMPLETION <br /> ----���Ground Surface <br /> Distance to sewer line Grout <br /> Domesticwell on site - (y/n ) <br /> If yes, location and distance - 4 9 q h <br /> Win. !v 2 �• <br /> m <br /> a <br /> SAMPLING = o <br /> M, — c <br /> ae^_^on <br /> Holding Temperature I = <br /> Method = gravel pack <br /> Screening Method — <br /> Tracking Sheet - (y/n) c <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) <br /> Storage Location Casing type Z r pu[ <br /> Blank_ /v 4 ft. Screen�to <br /> Slot size 0 <71n <br /> GROUTING Bags cement_ 1,G E re— gry,�, <br /> Buckets bentonite / 1, g gam, <br /> Depth to water <br /> Mix Ratios Bags sand/gravel / ps <br /> Filter Pack type/size Sre Np a v <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n) <br /> EH 29 29 Type of method <br />