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v MONITORING WELL INSTALLATION REPORT <br /> Date: ll 5A 9 CONSTRUCTION / <br /> Premise Address: D 2 S bl)I s.K L Total Depth 5 /r`&x:,L <br /> ' ' 2 3 Screen Length (from) (to) <br /> Well No.: i Filter Pack_ (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout <br /> (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. 3A LD. <br /> Drilling Company: Completion - Stove pipe/christie box (circle one) <br /> J�a - �v�' ✓rte <br /> Driller. _ '�' 7 � casing <br /> /� <br /> _1 Z �� height <br /> Consultant li✓^+.o) c f• <br /> Geologist k;a tj m L <br /> ABOVE-GROUND <br /> COMPLETION CHRISTY4= <br /> SPECIAL PERMIT INFO. Ground SurfCOMPLETION <br /> •-- Surface <br /> Distance to sewer line orae <br /> Domestic well on site - (y/n) l <br /> If yes, location and distance - -L -ft. <br /> ft ft. <br /> Yh• O <br /> O <br /> SAMPLING = o <br /> slotted — c <br /> �< <br /> Holding Temperature sacton <br /> — <br /> Method = gravel Pads <br /> Screening Method <br /> Tracking Sheet - (y/ n) ' <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT � <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type ~ <br /> Blank ft. Screen fr. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> EH 29 29 Type of method <br />