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MONITORING WELL INSTALLATION REPORT <br />Date: 7. ( 2 Z <br />Premise Address: % n, �( 44z V1 <br />Well No.: Mkk/ <br />Inspector: V)r%A^A C � � — <br />Permit No. <br />Drilling Company: C'ex" <br />Driller: T 0 <br />Consultant ro'_Kk ' <br />Geologist ff/"kf- <br />SPECIAL PERMIT INFO. <br />Distance to sewer line <br />Domestic well on site / n ) <br />If yes, location distance - <br />SAMPLING <br />Holding TemperatureC-jt i rao. <br />Method6"(4, =a l o <br />Screening Method <br />Tracking Sheet - ( y / n ) <br />SPOILS <br />Storage Method CAMAWW a, <br />Contamination Noted - ( y / n) f1/) P� �' 2,0 <br />Storage Location c+ s i k <br />GROUTING <br />Depth to water <br />Mix Ratios <br />Installation Method <br />Quantity Installed <br />EH 29 29 <br />6 <br />Total Depth 95 <br />Screen Length (from) 30 (to) q S <br />Filter Pack (from) g2 J6- (to) Ll <br />Bentonite (from)_(to) Fs <br />Grout (from)_(to) <br />Drilling rig type <br />Auger O.D. I.D. <br />Completion - Stove pipe/christie box (circle one) <br />casing <br />height <br />ABOVE -GROUND <br />COMPLETION <br />M IO <br />Ground Sudan <br />grout <br />4r n. <br />30 VX ft. <br />as <br />stoned <br />soc4on ;R <br />pmol Pack <br />i <br />y 5 ft. <br />MATERIALS/DEVELOPMENT <br />Casing type -7-' P V <br />Blank l'' ft. Screen 3,b ft. <br />Slot size o ib <br />Bags cement <br />Buckets bentonite <br />Bags sand/gravel <br />Filter Pack type/size z t z n. . Q <br />Surge Block: - ( y / n ) <br />Discussed with geologist: - ( y / n ) <br />Type of method <br />• <br />