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MONITORING WELL INSTALLATION REPORT <br /> Date:_ 7La5//q CONSTRUCTION <br /> Cis/.G o,� �vE�a�✓�i iI� <br /> Premise Address:_ Mck. t 1-WIP we Total Depth N.s <br /> Screen Length (from) d 7r ' (to) ' <br /> Well No.: /''✓a/ -j1S Filter Pack (from) a7.S" (to) <br /> Bentonite <br /> d f/f3 <br /> Inspector: Groutite (from) a y0 (to) <br /> (from) 'VS (to) U <br /> Drilling rig type vsi v/DV-,V*—,y� <br /> Permit No. Auger O.D. G YY I I.D. <br /> Drilling Company:. 6~;- pX_iiG/,✓* Completion - Stove pipe/christie box (circle one) <br /> Driller: koR' 1Z9mjy-fv casing <br /> q � height <br /> Consultant AMWI( <br /> Geologist JAmy� ��yayh�,o„/ ,_ �► <br /> ABOVE-GROUND <br /> COMPLETION CRRZ Y-BOX <br /> SPECIAL PERMIT INFO. G=nd Suriacs COMPLETION <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n ) a ys ft <br /> If yes, location and distance - <br /> r <br /> SAMPLING sbtted _ <br /> sac-don = <br /> Holding Temperaturewiy <br /> Method v&"Q Pack <br /> Screening Method A <br /> Tracking Sheet - (y/n <br /> SPOILS 875 , <br /> Storage Method 12W P'r 01W _MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) Tei <br /> Storage Location )Whoig Casing type $o lt# IVII <br /> Blank dSD ft. Screen ao ft. <br /> Slot size O.oa <br /> GROUTING Bags cement <br /> Buckets bentonite d' < /,fir✓ a0(k1 <br /> Depth to water Bags sand/gravel_ / 0/k /6la <br /> Mix Ratios Filter Pack type/size 6.1,,/r .43 <br /> Installation Method Surge Block: -a/ n ) <br /> Quantity Installed Discussed with geologist: - (q/ n ) <br /> EH 29 29 Type of method <br />