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MONITORING WELL INSTALLATION REPORT <br />Date:S 6 �O <br />Premise A ddress: �-S (�.0 <br />Well No.• XAW -\ <br />Inspector. <br />Permit No. 5- a- 5 <br />Drilling Company: <br />DriIler:_ <br />Consultant <br />Geologist L^�c <br />SPECIAL PERMIT INFO. <br />Distance to sewer line <br />Domestic well on site - <br />If yes, location stance - <br />SAMPLING <br />Holding Temperature rr,,, tri <br />Method�f���l�.�� <br />Screening Method fl o <br />Tracking Sheet - CyY n ) <br />SPOILS <br />Storage Method V-"A-A"ai e <br />Contarrtinadon Noted - 0/ n ) <br />Storage 1,6cadon 16 S, <br />GROUTING <br />Depth to water <br />Mik Rados <br />4pstalladon Method <br />Quantity installed <br />EH 29.29 • <br />0 <br />I <br />CONSTRUCTION <br />Total Depth -3f.-5- T I> " <br />Screen Length (from) (to) --" <br />Filter Pack (from) (EO) <br />Bentonite (&om),f O) n� . <br />Grout (from) Is(ta) <br />Drilling rig type <br />Auger O.D.' l2 I.D. <br />Completion - Stove pipe/christie box (circle one) r <br />grout <br />_ 1`I,7' ft. <br />seal <br />I�•S.�ft. <br />eft• <br />gravel pack <br />seal <br />7 7a3 3 & <br />gravel pack <br />3a�S ft.. <br />ft. <br />MATERIALS/DEVELOPMENT <br />Casing type Z" PVC. <br />Blank fr. Screen ft• <br />Slot size -07n <br />Bags cement <br />Buckets bentonite <br />Bags sand/gravel <br />Filter Pack type/size 3 We 5, sr do ;l <br />Surge Block: - (y 01 <br />Discussed with geologist: - ( y /lh-1 <br />Type of method <br />0 <br />