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MONITORING WELL INSTALLATION REPORT <br /> Date: l I n ,� CONSTRUCTION <br /> 4 <br /> Premise Address: Clio, �7 4.&,j <br /> -kd Total Depth 2-0 <br /> ` Screen Length (from) Zn (to) 0 <br /> Well No.:�[ 49 Filter Pack (from) 20 (to <br /> Bentonite (from) (to' <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion- Stove pipe/christie box (circle one) <br /> Drilling Company: U <br /> Driller: casing <br /> Geo height <br /> Consultant T <br /> Geologist �. r <br /> ABOVE-GROUND <br /> COMPLETION CHAlS1Y-80X <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surf=* <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) _ft. <br /> If yes, location and distance - <br /> ft. ft. <br /> SAMPLING = ° <br /> •btwd <br /> &goon — <br /> Holding Temperature �w Pack <br /> Method _ gr' <br /> Screening Method <br /> Tracking Sheet - (y/n ) ` — <br /> ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) <br /> Storage Location Casing type <br /> Blank I ft. Screen to ft. <br /> Slot size 0 . o2- <br /> GROUTING Bags cement <br /> ,✓��/ Buckets bentoni e �b <br /> Depth to water Bags sand/gravel S <br /> Mix PlatiOs-A&I If Filter Pack type/size ?//ac' <br /> Installation Method Surge Block: - ( y/ n) <br /> Quantity Installed U Discussed with geologist: - (y�) <br /> Type of method <br /> EH 29 29 U 0- <br />