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MONITORING WELL INSTALLATION REPORT <br />Date: z z y I O 4 <br />Premise Address:_- --S L /a -Ln," i4 T E,4(ni , <br />Well No.: rol W - <br />Inspector: <br />Permit <br />Drilling Company: (- <br />Driller: SZ2 <br />Consultant a T -\c <br />Geologist 1'�'i e - <br />SPECIAL PERMIT INFO. <br />Distance to sewer line <br />Domestic well on site - <br />If yes, location and jia ance - <br />SAMPLING <br />Holding Temperture 0-1A L C <br />Method h" � -c 10 <br />Screening Method <br />Tracking Sheet - ( y / n ) <br />SPOILS <br />Storage Method <br />Contamination Noted - n ) /J <br />Storage Location csv�tr ��. 186n..��ov,n.�saa..Y <br />GROUTING <br />Depth to water <br />Mix Ratios <br />Installation Method <br />Quantity Installed —`,� n c ..I I' .� <br />EH 29 29 <br />0 <br />Total Depth L'15 <br />Screen Length (from) <br />.0 (to) N S <br />Filter Pack (from) d - T' (to) ql <br />Bentonite (from) a (' (to) L& <br />Grout (from) �9- (to) 2-6, <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 />OO&FLEfION <br />cA <br />grout <br />z6 ft. <br />�Q.ft. ft. <br />- O <br />abned M _ 8 <br />wc5on � _ <br />gavel Pack <br />5 ft. <br />MATERIALS/DEVELOPMENT <br />Casing type -2-'P\)(!- <br />Blank 3o ft. Screen l5 ft. <br />Slot size 0 10 <br />Bags cement <br />Buckets bentonite I <br />Bags sand/gravel .v <br />Filter Pack type/size '- \z <br />Surge Block: - (y / n)—� <br />Discussed with geologist: - ( y / n ) <br />Type of method <br />• <br />