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MONITORING WELL INSTALLATION REPORT <br /> Date: Z � I[�� CONSTRUCTION <br /> Premise Address: Total Depth so <br /> /tnot�l s lo(e o—rov-�( Screen Length (from) o (to) $B <br /> Well No.:_M lA1-5. Filter Pack (from) S 15- (to) TC0 <br /> Bentonite (from) (P (to) & <br /> Inspector: _ LMI,)AC-rl , Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: <br /> Completion - Stove pipe/christie box (circle one) <br /> �,.�� I <br /> Driller: ic oL YV Ad-af/ ?- V <br /> casing <br /> height <br /> Consultant "£ T <br /> Geologist AV' ) {tntiL T <br /> AWVE-GROUND <br /> COMPLETION CiiAISTY-Box <br /> SPECIAL PERMIT INFO. GroundSurfaceCOMPLETION <br /> Distance to sewer line Grp <br /> Domestic well on site - (y/ n ) 1 S6 R <br /> If yes, location and distance - (' R <br /> fin. <br /> _= m <br /> P <br /> - 0 <br /> C <br /> SAMPLING — <br /> abttad = B <br /> sac5on <br /> Holding Temperature_�g',r..2 <br /> 6 n G__ gravel pad <br /> Method <br /> Screening Method p 1 17 (} <br /> Tracking Sheet - (y/n ) — <br /> SPOILS <br /> Storage Method S S��cf� d� MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y <br /> Storage Location Casing type L PVC: <br /> Blank 6G ft. Screen Zy ft. <br /> Slot size '0 z. <br /> GROUTING Bags cement N 1 <br /> / Buckets bentonite t <br /> Depth to water N b Bags sand/gravel NG <br /> Mix Ratios V O Filter Pack type/sizeAL3 <br /> Installation Method Surge Block: - ( y tt)) <br /> Quantity Installed ry 1 Y 0 ae✓` jDiscussed with geo ogist: - (y <br /> Type of method <br /> EH 29 29 <br />