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MONITORING WELT, INSTALLATION REPORT <br /> Date: 3(9 O CONSTRUCTION <br /> Premise Address: ZO S - Total Depth 5 <br /> Screen Length (from) (to) f <br /> Well No.:_�i 1/11_ L 7 Filter Pack (from)_�'r* (to)� <br /> Bentonite (from) (to)_ a 3 <br /> Inspector. Grout (from) -e— (to) 2_ <br /> Drilling rig type <br /> Permit No. Auger O.D. <br /> Drilling Company: Completion - Stove pipe/ �ristie b .c (circle ane) <br /> Driller: � casing <br /> �► he=ght <br /> Consultant 'r V <br /> —EWTGeologist e _ .� <br /> ABOVE-GACUND <br /> CO hr�l.�`TfO�! C}�sRJSTY-30X <br /> co UETCN <br /> SPECIAL PERMIT INFO. C3raurd Surface <br /> Distance to sewer line proof <br /> Domestic well on site - ( y/ n ) a Lft. <br /> If yes, Iocadi ,stance - <br /> r <br /> G <br /> '• o <br /> SAMPLING <br /> slorvi �: � <br /> soden <br /> Holding Temperature r <br /> Method pnV14 Pack <br /> Screening Method <br /> Tracking Sheet - { y/ n ) _ <br /> SPOILS <br /> Storage Method 45 s' �tMATERIALS,_(DEVELOPMENC <br /> Contamination Noted - (y/ n ,� <br /> Storage Location �" Casing type_ 2--, <br /> �U <br /> Blank 2 ft. Screen <br /> Slot size • 0 2 d <br /> GROUTING Bags cement <br /> Buckets bentonite 1 <br /> Depth to water t Bags sand/gravel <br /> Mix Ratios p Filter Pack type/size 3 <br /> Installation Method Surge Block: - Il } <br /> Quantity Installed Discussed with eologist: - / n ) <br /> Type of mctliod 6".r — <br /> EH 29 29 <br />