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MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address: S'D etowa Ale, — Total Depth S <br /> Screen Length (from) (to) (� <br /> Well No.:.-. /�j1�—AzS — to Filtar Pack (from)_ (to) <br /> Inspector: 1/�;0,,; Bentonite (from) <br /> Grout (from) <br /> Drilling rig type_ /lilV'� JZC <br /> Permit No. 6P-4 Auger O.D. I.D. <br /> Drilling Company:_ <br /> �(.Z / Completion - Stove pipe/christie box (circle one) <br /> (�'� tr— <br /> Driller: <br /> r� casing <br /> height <br /> Consultant.__1�Qj i <br /> Geologist Rowy613 <br /> ABOVE-dROUND <br /> COMPLETION Ct-IMM 80X <br /> SPECIAL PERMIT INFO. Grourd Surixe COMPLETION <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n ) <br /> If yes, location and distance - ft. <br /> m <br /> = m <br /> : <br /> SAMPLING ototted 0 <br /> Bacton <br /> Holding Temperature <br /> Method — �'�pack <br /> Screening Method = <br /> Tracking Sheet - (y/n) _ <br /> SPOILS <br /> Storage Method M_ ATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type / <br /> Blank 5 ft. Screen_ -AZ ft. <br /> Slot size <br /> GROUTING Bags cement Z) Y, .7 <br /> Buckets bentonite <br /> Depth to wate Bags sand/gravel_ + 7, <br /> Mix Ratios 0? 4- Filter Pack type/size <br /> Installation Method_ X71 f-ct1 I E� Surge Block: - (y/ n ) <br /> Quantity Installed_ J'b XDiscussed with geologist: - (y/ n) <br /> Type of method <br /> EH 29 29 <br />