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MONITORING WELL INSTALLATION REPORT <br /> Date: Q 410 1!�- CONSTRUCTION <br /> Premise Address: .10 Sa Total Depth O Fr <br /> Pc� �4 Sy Screen Length (from) tis 74, (to) 25� ►• <br /> Well No.: V' Filter Pack <br /> (from) Z Z( �}- . (to) 2 Gv <br /> Inspector: 10 h nny/ yv� k�rh Grout �: <br /> Bentonite (from) L l7* 'r _ (to) Z2 f+, <br /> (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. <br /> Christie ircle one) <br /> Drilling Company: 6req b Ifi'4q -vid_ Tie&�j Completion - Stove pipe <br /> Driller: cas ing <br /> height <br /> Consultant <br /> Geologist <br /> T <br /> ABOVE-GROUND <br /> COf,r''Lti ZN CHRZTY80X <br /> SPECIAL PERMIT INFO. q Gerund Su rlaca COMPLETION <br /> A <br /> Distance to sewer line fl� <br /> Domestic well on site - (y/n ) <br /> If yes, location and distance - 2 2 <br /> z3s ft- n. <br /> 7 <br /> _= m <br /> - m <br /> C <br /> SAMPLING = <br /> slotted — � <br /> Holding Temperature <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/n) _ <br /> SPOILS 2 <br /> Storage Method W-.sfe- 0-0 04Ki^c✓' MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ ) <br /> Storage Location ©A Sit'G Casing type SC4fC/L)le go PV C <br /> Blank ft. Screen ft. <br /> Slot size 0.01��• <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel I°t <br /> Mix Ratios Filter Pack type/size S 4A� A�- 3 <br /> Installation Method Surge Block: - Y/ n) <br /> Quantity Installed Discussed with geologist: - & n) <br /> Type of method <br /> EH 29 29 <br />