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r� <br /> M MONITORING WELL INSTALLATION REPORT <br /> N <br /> Dater CONSTRUCTION <br /> Premise Address : zo 9-0 t , r=- � Jc - Total Depth_ _ <br /> S c Screen Length (from) `to (to) 5 3' <br /> Well No. : KQ � Z44 Filte;- Pack (from) rt. S S <br /> Bentonite (from) 3 S— (to) 3$ <br /> Inspector: Grout (from) !� _ � (to) <br /> Drilling rig type <br /> Permit No. Auger O.D._ I.D. 6 ' <br /> Drilling Company: <br /> Ay ) Completion - Stove pipe/christie box (circle one) <br /> Driller:_ k Pa t <br /> casing <br /> Q height <br /> A <br /> Consultant E <br /> Geologist <br /> ABOVEGROUND <br /> COMPLETION CHRZ7Y=BOX <br /> SPECIAL PERMIT 1NF0, Gmund Sudaca COMPLETION <br /> Distance to sewer line grout <br /> Domestic well on site - ( y / <br /> If yes, location and distance - 3S ft. <br /> ft ft, <br /> SAMPLING = ` <br /> 0 <br /> slotted <br /> Holding Temperature <br /> Method 9R P <br /> Screening Method f _ <br /> Tracking Sheet - ( y / n ) <br /> �S n• S ft. <br /> SPOILS <br /> Storage Method 61" MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y / <br /> Storage Location IJ v S , }� Casing type � o�' LAD e U c <br /> Blank k O ft. Screen S ft. <br /> Slot size O .ag " <br /> GROUTING Bags cement_ fl. <br /> u Buckets bentonite <br /> Depth to water W Bags sand/gravel-_VJ 14 16 <br /> Mix Ratios In l OK0 5 y hs Filter Pack type/size Vt <br /> Installation Metho(f Surge Block: - ( y /&) <br /> Quantity Installed Discussed with geologist: - / n ) <br /> Type of method <br /> EH 29 29 <br />