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MONITORING WELL INSTALLATION REPORT <br /> Date: -2 q I nr) CONSTRUCTION <br /> Premise Address:_ _ C7 Z Total Depth Li C) <br /> Screen Length (from) ;Ia ` (to)_ Ifo I <br /> Well No.: tM W – �� + M tk) f-A Filter Pack (from) ` (to) !jol <br /> Bentonite (from) f.5' _(to)__ <br /> . (to) i k <br /> Inspector. J:�"A„_A g2o I Grout (from) -F3 (to) i <br /> Drilling rig type <br /> Permit No. S YZ COC>Z Z_ Auger O.D. % ,z I.D. <br /> Drilling <br /> Completion - Stove pipe/cluistie box (circle one) <br /> Compannny:/n�__ WA A�r�.op�/ <br /> Driller: &L�eC _A casing <br /> V- 6 <br /> � heightConsultant Geologist �1 of i VV\A kAmo),- IV —aw, <br /> ABOVE-GRCUND CHEM Y-30X <br /> COMPL ErCN COMPL EMN <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line of10tn <br /> Domestic well on site - ( y/ n ) 7 1 ft. <br /> If yes, location and distance - ft. <br /> — c <br /> SAMPLING : = o <br /> secicn — <br /> Holding Temperature %- <br /> Method <br /> �,raval Fade <br /> �,"' s�o��,�, _ oQ�+.� __ <br /> Screenin;Method Ft r) <br /> Tracking Sheet • ( f n ) _ <br /> y: <br /> ft ft. <br /> SPOILS <br /> Storage Method 7`i c MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( / n ) <br /> Storage Location C-v\ Casing type PV <br /> Blank a.b ft. Screen tel, ft. <br /> Slot size , r-� t h <br /> GROUTING Bags cement ;_l yz- <br /> Buckets bentonite V-i <br /> Depth to water 1�l , -:7 Bags sand/gravel <br /> Mix Ratios Filter Pack type/size rAj I <br /> Installation Method A A 1elf Surge Block: - ( y ID <br /> Quantity Installed l - gc) '_4A Discussed with geologist: - (y/ <br /> EH 29 29 Type of method <br />