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MONITORING WELL INSTALLATION REPORT <br /> Date:__- 31Z`6I0`6 CONSTRUCTION <br /> Premise Address: 20 S'O :;j�"w c,,A Total Depth 17- 5, <br /> Screen Length (from) 11 S (to)- 12s- <br /> Well <br /> 2;-Well No.: M t ) - O Filter Pack (from) It ( (to) ( 2 �:;- <br /> Bentonite (from) JW (to) t14Inspector: hiAN ro Grout (from) (to)_ (ok <br /> Drilling rig type <br /> Permit No. S 3 SZZ Auger O.D. I.D. <br /> qq Completion- Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant T <br /> GeologistAN T <br /> ABOVE-GROUND <br /> OOMPLF-TION CMPLETI OX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line 7f0� <br /> Domestic well on site - <br /> If yes, location an stance - <br /> � ft. <br /> r-2im <br /> SAMPLINGdottedonHolding Temperature oyt 1 C.Method to " Gnr�Screening Method V1 I�Tracking Sheet - ft. 2 5 ft, <br /> SPOILS n/� <br /> Storage Method kku\ MATERIALS/DEVELOPMENT <br /> Contamination Noted - (3/n ) <br /> Storage Location m&c t f, Casing type L PU°L <br /> BlankjI t� ft, Screen <br /> Slot size •412P <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel_ <br /> Mix Ratios Filter Pack type/size Z t2 <br /> Installation Method Surge Block• - (y/ n ) ' <br /> Quantity Installed Discussed with geologist: - (& n ) <br /> Type of method <br /> EH 29 29 <br />