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MONITORING WELL INSTALLATION REPORT <br /> Date: - A CONSTRUCTION <br /> Premise Address: d,, Total Depth 30 <br /> Screen Length (from)_ 7_y (to) p <br /> Well No.:-62A Filter Pack (from) I�C- <br /> fnsPector: <br /> (to) zs <br /> ,� Bentonite (from)_ (' (to)___[��_ <br /> Grout (from) 76 <br /> (to) (� _ <br /> Permit No. 5-16 3`fDrilling rig type <br /> Auger O.D. I.D. <br /> Drilling Company: , <br /> Completion - Stove pipe/christie box (circle one) <br /> 9 <br /> Driller: <br /> casing <br /> Consultant —T is height <br /> 7 —QV—f <br /> Geologist_ nn �.��ti o ,« <br /> ABOVE-GROUND <br /> CO&PLETZN CHR18TY-aox <br /> SPECIAL PERMIT INFO COMPLETION <br /> Ground Surface , <br /> Distance to sewer line grout <br /> well on site - ( y/n ) <br /> If yes, location and distan fes_ft. <br /> Z ofttt. <br /> SAMPLING __ o <br /> 8101tad — c <br /> tQcaon = <br /> Holding Temperature — <br /> Method = 71-1 P-ack <br /> Screening Method <br /> Tracking Sheet — <br /> �L_ <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted ( y/ <br /> Storage Location Casing type <br /> Blank ZQ ft. Screen <br /> GROUTING Slot size <br /> Bags cement <br /> Depth to waterw S Buckets bentonite /3 <br /> Bags sand/gravel <br /> Mix Ratios ,v Filter Pack type/ ize <br /> Installation Method s <br /> ; „�_ „o P Surge Block: - ( y/ n <br /> Quantity Installed 1 <br /> Discussed with geologist: - ( y/V <br /> EH 29 29 Type of method <br />