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MONITORING WELL INSTALLATION REPORT <br /> Date: A -7-3 -- /[,/ CONSTRUCTION <br /> J <br /> Premise Address: 20t;z )= TeA16/ji 1J . Total Depth <br /> Screen Length (from) tip (to)_ b <br /> Well No.:_ Filter Pack (from) (to) <br /> Bentonite' (from) 45_(to) r�/,�'. <br /> Inspector: . ►/. WO 131 -- Grout (from) <br /> Drilling rig type <br /> Permit No. t)d 78'J$3 Auger O.D. N I.D. <br /> Completion- Stove pipe/christie box (circle one) <br /> Drilling Company:_ /� , <br /> Driller: casing <br /> height <br /> Consultant o <br /> Geologist C4/S <br /> ABOVE-GFOUND GHA15fY-80X <br /> 006FLEilON COMPLETION <br /> SPECIAL PERMIT INFO. Ground Sufi <br /> Distance to sewer line ®rout <br /> Domestic well on site - (y/n) J- ✓ <br /> h. <br /> If yes, location and distance - ft <br /> SAMPLING <br /> e-ec2on _ ' <br /> Holding Temperature 73 P <br /> Method _ <br /> Screening Method <br /> Tracking She (y/n) — <br /> . <br /> SPOILS <br /> Storage Methods XYZ- vI MATERIAL S/DEVELOPMENT <br /> Contamination Noted - (y/n) <br /> Storage Location dd✓/,/7 - 6Aw-E— Casing type 9 "�Fr. Vb / Vr-- <br /> Blank ft. Screen -Z�O ft. <br /> %�i�sit� Slot size <br /> GROUTING 7��ZT y�#13i1�l Bags x <br /> lT cQ Buckets bentomte 7a a R1X1LS7:S <br /> Depth to water Bags sand/gravel -:a ,- * <br /> Mix Ratios Filter Pack type/size 3 <br /> Installation Method 0 7AWX*i Surge Block:_(_y_/n_)_ — <br /> Quantity Installe x en 10 r 3 A�j1xk Discussed with geologist: - (y/ n ) <br /> EH 29 29 AF/ - Bh" f'3-0 6t(- y7 Type of method <br />