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MrI NITORING WELL INSTALLATION REPORT, <br /> Date: ('Z/-7'1 CONSTRUCTION <br /> Premise Address: Total Depth ADD <br /> Screen Length (from) /00 (to) 7S <br /> Well No.: �/�'�1i Filter Pack (from) /D a (to) T13 <br /> Bentonite (from) (to)--5 - <br /> Inspector: Grout (from) (to) a <br /> / Drilling rig type CM E 7 S = iwl,4P4e <br /> ?ermit No. Q Auger O.D. I.D. 4 <br /> Completion - Stove pip c e box circle one) <br /> Drilling Company: <br /> Driller: SCOT casing --- <br /> height <br /> Consultant �S <br /> T <br /> Geologist 'be- 1/ ABOVE-GROUND <br /> CON91 ETON C�iA!STY-8OX <br /> COMPLET'! <br /> SPECIAL PERMIT INFO. Ground Surface <br /> grout <br /> Distance to sewer line <br /> Domestic well on site ( Y<D ft <br /> If yes, location and distance - -�� n• <br /> ft. <br /> m <br /> 0 <br /> Slotted �r _ <br /> SAMPLING socton X-t <br /> Holding Temperature _— <br /> Method <br /> Screening Method /A = <br /> Tracking Sheet y n ) <br /> SPOILS r� <br /> Storage Method CrA- MATERIALS/DEVELOPMENT <br /> Contamination Noted - <br /> Storage Location_ Casing type <br /> Blank h. Screen Z5 ft. <br /> Slot size L.O <br /> GROUTING Bags cement_,( <br /> r Buckets bentonite <br /> Depth to water c6f ��r Bags sand/gravel <br /> Mix Ratios D o S e > Filter Pack type/size <br /> Installation Meth d1/" Surge Block: - 6Y n ) <br /> Quantity Installed 3 deo Discussed with geologist: - 0/ n ) <br /> Type of method � 4 <br /> y� �% Z, 3 <br />