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MONITORING WELL INSTALLATION REPORT <br /> Date:__ c7 - I 7 CONSTRUCTION <br /> Prems45v/ 008'7 <br /> PremiseAddress: W '�$�21 �f;� Re)*;S Total Depth <br /> Well No.; M W ' S Screen Length (from) 6 (v (to) 8 6 <br /> Filter Pack (from)_ 6, 41 (to)—E7 <br /> �a� ,yt Bentonite (from) (' 7– (to) G, q <br /> Inspector: Grout (from) (to) <br /> Permit No. <br /> 76�(q�( Drilling rig type 4 Qi14� u <br /> –/ Auger O.D. 15 05A I.D. <br /> Drilling Comp <br /> Completion - Stove pipe/christie box (circle one) <br /> Company:_ V €' W <br /> Driller: \j 1< casing <br /> Consultant_ t��.E I N F6/ height <br /> Geologist_ !! Atj #144 '1 _ <br /> ABOVE FOUND <br /> OOlfp'. {ON CNFISTY=8OX - <br /> z <br /> SPECIAL PERMIT INFO. T� ��saAtxe COMPLETION <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n) <br /> If yes, location and distance - h• <br /> h. <br /> r � <br /> 4 0 <br /> SAMPLING Cotted c <br /> sacdon <br /> Holding Temperature Al <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/n) <br /> SPOILS <br /> Storage Method 61Y0" '� d�^ Pr` ' 7 M.'TFRIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) QvC <br /> Storage Location Casing type I <br /> Blank ry (a ft. Screen '2o ft. <br /> Slot size 0. 0/0 <br /> GROUTING Bags cement <br /> y t Buckets bentonite l 15 RG <br /> Depth to water / /2 Bags sand/gravel <br /> Mix Ratios Filter Pack type/size -0-7-41& S4NJ� <br /> Installation Method M iXP.r pT— Surge Block. -ry n ) <br /> Quantity Installed T Discussed with eologist: - (y/ n) <br /> EH 29 29 <br /> Type of method <br /> " <br />