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f MONITORING WELL,INSTALLATION REPORT <br /> Date:4.t+c. 11040 71d'f rA 1, y/1�p� CONSTRUCTION <br /> Premise Address: Total Depth 1 / S <br /> Well No.: PVl ln/- 1 <br /> Screen Length (from) toy (to) <br /> Filer Pack (from) .D�_(to)_�I S <br /> Bentonite (from) 901 (to)_ )02- 1 <br /> Inspector._ he � , Grout (from)- (to)— <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/clu"isde box (circle ane) <br /> Drilling Company <br /> Driller: [ff casing. <br /> height <br /> Consultant S + <br /> Geologist <br /> ` ABOVE-GRCUND <br /> tX)WL E DON G2 RSTY 3oX <br /> SPECIAL PERMIT INFO. GrWnd Suixt CIOMPLEMN <br /> Distance to sewer line Grout, <br /> Domestic well on site.- ( <br /> If yes, location and ance - IL. <br /> r; - <br /> SAMPLINllor�d '2G <br /> Holding Temperature 01/\ r Cl< <br /> Method ���steRnn.. . - <br /> Screening Method 3D- <br /> Tracking Sheet - (y/ n ) <br /> 1�.tt. <br /> SPOILS <br /> Storage Method MATERTALS/DEVELOPMENT <br /> Contamination Noted - y/n) <br /> Storage Location Casing type "Z <br /> Blank (SS ft. Screen--i-6—fl. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> MiX Rados Filter Pack type/size <br /> -Installation Method Surge Block: - (y/ n ) <br /> Quantity installed Discussed with geologist: - (y/n <br /> Type of method <br /> EH 29 29• . <br />