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MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTAUCTTON <br /> Premise Address: S S 004 Total Depth 4 r7 t <br /> Screen Length (from) S ` ([o} Zo <br /> Well No.: -y Filter Pack (from) ' (to)—.? 0 <br /> Bentoaite (from) <br /> Inspector: Grout (from) -�-,T(to}_ !•'_� <br /> Drilling rig type <br /> Permit No. O n A +-{ 3:nAuger O.D. I.D. <br /> Drilling Company: A <br /> Completion - Stove pipe/ uistie bo {tircle one) <br /> Driller �— casing <br /> height <br /> Consultant <br /> T <br /> Geologist C ,V11_ T <br /> ABOVE-GSCUND CHRLS7Y-a0X <br /> COWI��T1DN c,�t_mct� <br /> SPECIAL PERMIT INFO. �,�5�,� <br /> Distance to :ewer line grout <br /> Domestic well on site - ( y/ n ) <br /> If yes, Iocation and distance - A— <br /> vm3 <br /> ft. <br /> , <br /> 4" O <br /> O <br /> C <br /> SAMPLING — <br /> +oc�crs " 3 <br /> Holding Temperature CDA- rA <br /> Method " — RiYA PackScreening Method PA 9 <br /> Tracking Sheet - n ) --- <br /> SPOILS <br /> Storage Method mA MATERIAIS[DEVELOPMENT <br /> Contamination Noted - y <br /> Storage Location Casing type -2. N 10 <br /> BIanit_ fr- Screen f h. <br /> Slot size OZ 0 <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water _ i1 `6 S Bags sand/gravel .� <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - ( y/(fi-) <br /> Quantity Installed Discussed with geo ogist: - (y/0 <br /> EH 29 29 Type of method <br />