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MONITORING WELL INSTALLATION REPORT <br /> Date: S�Zy 'OU CONSTRUCTION <br /> Premise Address: h(�2 ���, L rn 1�• c.� Total Depth ��D <br /> V Screen Length (from) ` (to)� <br /> Well No.: I1�W- �j Filter Pack (from) (to)� <br /> Bentonite (from) (to)� <br /> Inspector. Grout (from) (to) <br /> Drilling rig type <br /> Permit No. i(Z V O 2 Z -;T Auger O.D. :�C I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company-. <br /> Driller: _k casing <br /> 7- height <br /> Consultant �� V <br /> Geologist_ I� in h t'V�,t.r'.� rata -- T <br /> AE0V .GACIUND CHR TY-t30X <br /> CCMPLFrCN COMPLEMCN <br /> SPECIAL PERMIT INFO. Ground Surface 7— <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) 15 ft. <br /> If yes, location and distance - ft. <br /> SAMPLING = <br /> socicn — � <br /> Holding Temperature CnA 1 C4r =_ <br /> Method I,'' I U C„_,,,-. ¢nom _ pn"w Pa.* <br /> Screening Method to I f _ <br /> Tracking Sheet / n ) <br /> �d fi, 'w = L ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y n <br /> Storage Location_ rnn Casing type Z Py <br /> Blank 'ZO ft. Screen Zd ft. <br /> Slot size e t O <br /> GROUTING Bags cement vR ` i- <br /> Buckets bentonite 3/tet -«�r <br /> Depth to water5 . i Bags sand/gravel <br /> Mix Ratios Filter Pack type/size -2-Itz <br /> Installation Method _ Surge Block: - ( y//fid <br /> Quantity Installed Discussed with geo ogist: - (y C <br /> EH 29 29 Type of method <br />