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MONITORING WELL INSTALLATION REPT <br /> Date: d �` ! CONSTRUCTION <br /> Premise Address: 3C wT Total Depth <br /> Screen Length (frown) (to)_53_ <br /> Well No.: t(.� _ _ Filter Pack (from) 3 / (to) 45i3 �_– <br /> Bentonite (from) Z (to) 3/ <br /> Inspector: At Grout (from) (to)_7_6_'__ <br /> Drilling rig type .SA <br /> Permit No. Auger O.D. //0 I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: L1/- l - <br /> Driller: ��-� .._ casing <br /> j height <br /> Consultant_ ,�-(!�`�v s <br /> 77 <br /> Geologist c� art ev— T <br /> ABOVE-GROUND <br /> oor FLETIO v C*SZT 4= <br /> SPECIAL PERMIT INFO. G=nd Sirfacs COMPLETION <br /> Distance to sewer line Grout <br /> Domestic well on site - (y/ n) tt. <br /> If yes, location and distance - <br /> n. 7 F_ <br /> ft. <br /> s� O <br /> C <br /> SAMPLING o <br /> sbt>ad c <br /> aacdon <br /> Holding Temperature J _ <br /> Method �~ — Gravel pack <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 ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack typesize <br /> Installation Method Surge Block: - (y/ n) <br /> Quantity Installed Discussed with geologist: - (y/ n) <br /> Type of method <br /> EH 2929 ' <br />