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MONITORING WELL INSTALLATION REPORT <br /> Date:— z 1 Z_b��OF� CONSTRUCTION <br /> Premise Address: ZDSo A4PI'Ac'.L4 Total Depth ( 2.1 <br /> Screen Length (from) 10 ( (to) 12� <br /> Well No.: H Ini Filter Pack (from) 94- (to) l z 7 <br /> Bentonite (from)_ (to) 113- <br /> Inspector: <br /> J3.Inspector: "e'r,L Grout (from) (to) 17 CY — <br /> Drilling rig type <br /> Permit No. S3 SZ Z Auger O.D. I.D. <br /> Completion- Stove pipe/christie box (circle one) <br /> _Drilling Company: o-A—.An,.,..rr c— <br /> Driller: casing <br /> jffT <br /> height <br /> Consultant_ArrqE_ /�� <br /> Geologist._- W f r�12,1 LL ! .. 7 <br /> ABOVE-GROUND CHAISTY-BOX <br /> COh�IE?ION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surlacs - <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ ft <br /> If yes, location and di s ce - <br /> �n1 ft. ft. <br /> — m <br /> q <br /> 0 <br /> C <br /> SAMPLINGs� = 9 <br /> _ c <br /> tocuon — <br /> Holding Temperature���kC r = �P <br /> Method 1, " Int. �[p. 4 = -.' <br /> wk <br /> Screening Method V 1 0 <br /> Tracking Sheet -©/n ) " — <br /> :A _ : <br /> 12-1 ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - y n ) <br /> Storage Location rfrn sr Casing type <br /> Blank_____A o �_ft. Screen ZA ' ft. <br /> Slot size 0 <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size, allI rk.u w <br /> Installation Method Surge Block: - ©/ n ) <br /> Quantity Installed Discussed with geologist: - (y�) <br /> Type of method <br /> EH 29 29 <br />