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MONITORING WELL INSTALLATION REPORT <br /> Date3 <br /> -7 CONSTRUCTION <br /> Premise Address:- `;FC-G� Total Depth_ �; t "�t_•`� <br /> Well No. M o) �C Screen Length (from) <br /> Filtet Pack (from) <br /> Inspector: _ �-yDfyut*" Bentonite' (from)_ • �; (to) <br /> Grout (from) C-� (to) _ <br /> -,: 00 -7U Z I Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: CO1Lt /JL Completion- Stove pipe/christie box (circe one) <br /> Driller:_ Ir U 1 10 casing <br /> height <br /> Consultant <br /> Geologist-.j <br /> ABOVE-GROUND <br /> cowLFf104 CHMM-BOX <br /> SPECIAL PERMIT INFO PLETION <br /> ��/� Ground Surfxa <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n) y� <br /> If yes, location and distanceCO <br /> _ - <br /> � r <br /> SAMPLING I ' <br /> / I /) abtted o <br /> LQC.IOn <br /> Holding Temperature = <br /> Method _= gr,viW pack <br /> Screening <br /> Tracking Sheet - (y/n) _ <br /> SPOILS <br /> Storage Method_ !J \.A MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) - L r <br /> Storage Location-�1/�2- i.J/1 ;2 ;o"ht� Casing type <br /> Blank 'k- ft. Screen t i, ft. <br /> GROUTING Slot size J 'J ,Q-10,; <br /> Bags cement '3/11 W Lfh) <br /> Depth to water <br /> Buckets bentonite I <br /> l,a Bags sand/gravel_ <br /> Mix Ratios_ ;1 >.i1o.1 11 �� ; II-J�Filter Pack type/size r <br /> Installation Method_ u` •>tr a��,.� j�t,,.1 :� <br /> ._.-Surge.- ) <br /> Quantity InstalledDiscussed with geologist: - (y/n) <br /> EH 29 29 ctl- Q- <br /> Type of method <br />