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MONITORING WELL INSTALLATION REPORT <br /> Date:_ h r z� IT�R CONSTRUCTION <br /> Premise Address:-&n Z a � Total Depth U <br /> Well No.: Screen Length (from)_ C7 ` (to)----LLC-L7— <br /> Filter Pack (from) $` <br /> Inspector. _ 1� t,�,,,�r. � Bentonite (from)_ I <�`—(to)� <br /> Grout (from) <br /> Permit No. Drilling rig type <br /> Auger O.D. <br /> Drilling Company:_ ���, „� Completion - Stove pipe/ iristie box ;(circle one) <br /> Driller: <br /> T— casing <br /> Consultant � <br /> height <br /> Geologist <br /> AF3CVE-GAC4JND <br /> COOL ETION C4-RISTY-aox <br /> SPECIAL PERMIT INFO. CAMPLEMN <br /> Ground Suface <br /> Distance to sewer line <br /> Domestic well on site - n ) grout <br /> If yes, location and d' ante • :-ft. <br /> °�U <br /> Y' O <br /> SAMPLING = <br /> Holding Temperature soc9cn <br /> Method (5is. gnvaf Facie <br /> Screenin;Method_ I -- <br /> Tracking Sheet - (y/ n ) _ <br /> SPOILS C) tt. tt. <br /> Storage Method_ s S�y-�O(^,�� <br /> Contamination NotedMA�� � I OPMENi' <br /> Storage Location ,� <br /> Casing type_ L p V <br /> Blank ZC.� ft. Screen_ Z f, <br /> GR.OLr Slot size_ r -Z-C-) <br /> Bags cement N <br /> Depth to water Buckets bentonite t 7- <br /> -Mix <br /> Mix Ratios Bags sand/gravel <br /> Installation Method ' Filter Pack type/size <br /> Quantity Installed Surge Block: - (yii <br /> Discussed with geologist: - (y C) <br /> FH 29 29 Type of method <br />