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MONITORING WELL INSTALLATION REPORT <br /> V )�-G^ o":A ' -Z 56 (rte <br /> Date: s f z 3 0 C> CONSTRUCTION <br /> i <br /> Premise Address: n? K) Total Depth S� <br /> Screen Length (from) (to). 15-0Well No.: 'WA (J - �� -) � " Z. Filter Pack (from) .1 16 (to) <br /> Bentonite (from) A 5 (to) 3S <br /> Inspector. �'(��A,,,,e-a Lr Grout (from) (to) 01 -S- ) <br /> Drilling rig type <br /> Permit No. O o 'Z Z �� Auger O.D. s'z 5 " I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> ,, <br /> Driller: Le./�JIA A OA IIni:aj <br /> 1casing <br /> height <br /> Consultant ��� '4 \ <br /> Geologist_ 1 eA t-\ WL/ 14A a,,, .. T <br /> ABCVE-GRCUNO Ci-StSTY-30X <br /> COMPL�FTION COMPL.ETiCN <br /> SPECIAL PERMIT INFO. Ground Surfaas <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) 'Z s ft. <br /> If yes, location and distance - Z �. <br /> ti•• o <br /> — r <br /> SAMPLING : _ <br /> soden — <br /> Holding Temperature oh C <br /> Method- t Lie ! V3,W Pack <br /> Screening Method <br /> Tracking Shcet / n ) <br /> S 0 ft. C-C) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - y n ) <br /> Storage Location CIA 51Casing type <br /> Blank fr. Screen fr. <br /> Slot size o 10 <br /> GROUTING Bags cement <br /> Buckets bentonite 3/1t 6u-k <br /> Depth to water_ N_ 02 S Bags sand/gravel S <br /> Mix Ratios Filter Pack type/size fl <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> EH 29 29 Type of method <br /> �► <br />