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MONITORING WELL <br />INSTALLATION REPORT <br />Date:_ <br />CONSTRUCTION <br />Premise Address: QZd l it 6 - Wa <br />� bh� gTotal Depth <br />1 <br />B O <br />MATERIALS/DEVELOPMENT <br />Well No.: FMS-. Wl W V <br />Screen Length (from) 2 S-- <br />(to) 0 <br />Inspector: \J-0 '- <br />Filter Pack <br />Bentonite <br />(from)_ Z 3 <br />(from) 18, <br />(to)_,S- a <br />�j <br />Grout <br />Drilling <br />(from) O <br />(to) V <br />Permit No. 6 S <br />rig ty <br />e; <br />- ... -- -- . _... .... <br />Quantity Installed <br />Drilling Company: p a,r <br />Auger O.D. $ S I.D <br />Completion -Stove pipe stie bo <br />—_ <br />Discussed with geologist: <br />(circle one) <br />Drill e;:_ Da V . ` Q � —TiP <br />Consultant D 7-1 F <br />Geologist a <br />SPECIAL PERMIT INFO. <br />Distance to sewer line <br />Domestic well on site - ( y / n ) <br />If yes, location and distance - <br />SAMPLING <br />Holding Temperature <br />Method <br />Screening Method <br />Tracking Sheet - ( y/ n ) <br />SPOILS <br />casing <br />height <br />q 9 <br />ABOVE -GROUND <br />C OWLETION CNRZ7Y-BCX <br />COMPLETION <br />C3rrourxl Surface <br />Dry <br />A - <br />C <br />�Iottad —• c <br />sxaon '- .S <br />= gr a va? pack <br />._•tel.. ft. `"• �� (� , ft. ' . <br />Storage Method <br />Contamination Noted -(Y/n) <br />MATERIALS/DEVELOPMENT <br />Storage Location <br />Casing type q O )o uC � Z ► � <br />S c � • ' <br />Blank ft. Screen_ Z ,f ft. <br />GROUTING <br />Slot size_ ' Q 20 <br />Bags cement_ ) Z. <br />Depth to water +'� <br />Buckets bentonite_ Z <br />Mix Ratios ��� <br />Bags sand/gravel <br />Installation Method <br />Filter Pack type/size L44 <br />- ... -- -- . _... .... <br />Quantity Installed <br />Sur e Block:= - <br />----- - g - (-Y--/ n_) v� <br />—_ <br />Discussed with geologist: <br />EH 29 29 <br />Type of method . <br />