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MONITORING WELL INSTALLATION REPORT <br /> Date:hda CONSTRUCTION <br /> Premise Address: 3 S $bd Total Depth SI <br /> i'2 Screen Length (from) (to)__ <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> . . Drilling rig type <br /> Permit No. <br /> Auger O.D. I.D. <br /> Drilling CompCompletion - Stove pipe/christie box (circle one) <br /> any: �5.� <br /> Driller: casing <br /> height <br /> Consultant :'j C_1 <br /> Geologist_eizY.tuw <br /> ABOVE-GROUND <br /> COMPLETION CNAtm-80X <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Sumac <br /> Distance to sewer line_64_ L grout <br /> Domestic well on site - (y n ft. <br /> If yes, location and distance - <br /> ft. <br /> ft. <br /> his p <br /> SAMPLING _ <br /> •bttad <br /> vection <br /> Holding Temperature-Pik <br /> ik <br /> Method ' _ gr"W P <br /> ack <br /> Screening Method A. <br /> Tracking Sheet - (y/n ) h <br /> ft- <br /> SPOILS SI <br /> Storage Method ��t MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type a-r1lFVy <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement Z q 7 Al <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios CAW^A Filter Pack type/size <br /> Installation Method U Surge Block: - ( y/n ) <br /> Quantity Installed Discussed with geoloist: - y/ n ) <br /> Type of method, &-- -6U1� <br /> EH 29 29 <br />