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MONITORING WELL INSTALLATION REPORT <br /> Date: ps 'v� CONSTRUCTION <br /> Premise Address : Zo C-b C . Rvr� s } Total Depth TD <br /> S Screen Length (from) 00 <br /> 1 (to)_ 1 -2 ,7 <br /> Well No. : T34%4 - S Filter Pack (from) lb <br /> (t0) 1 Z <br /> � ,�� Bentonite (from) 9 S (to)� <br /> Inspector: O �M Grout (from) o ' (to)PermitNo,No. Drilling rig type LAn�ocL �4 � �-- <br /> Auger O.D. 8 . zC4 LD• 9S" <br /> Drilling Company: <br /> Completion - Stove pipe/christie box (circle one) <br /> - � l�' <br /> Driller: 5oc .n cr � r casing <br /> V height <br /> Consultant <br /> Geologist <br /> ASOVE-GROUND <br /> C OWLEilON WCOMPN <br /> SPECIAL PERMIT INFO. G=r>d Surface <br /> Distance to sewer line 1 c f grout <br /> Domestic well on site - ( y /0 � qr <br /> If yes, location and distance - <br /> fro ft9i�s h <br /> SAMPLING <br /> aacvon — n <br /> Holding Temperature <br /> Methodg "vv� pack <br /> Screening Method 1 <br /> Tracking Sheet - ( y / n )` <br /> 12u = 12� n <br /> n. — <br /> SPOILS <br /> Storage Method b!)A^ Dr.r.; ka. MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y / n <br /> Storage Location O+ Casing type SC if 40 f C <br /> Blank 1a%> $. Screen <br /> Slot size <br /> GROUTING Bags cement LID . <br /> Buckets bentonite_ <br /> Depth to water LAO Bags sand/gravelrqt4 1� <br /> Mix Ratios (9 c \ o e f 414 f 6s 1Filter Pack type,Lgize 7L <br /> Installation Method -rvevv), Surge Block: - Ul n ) <br /> Quantity Installed Discussed with geologist: - / n ) <br /> Type of method <br /> EH 29 29 <br />