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- MONITORING WELL INSTALLATION REPORT <br /> Date:- It D CONSTRUCTION <br /> Premise Address: y r f C fn Total Depth 3 7 S 1 <br /> Well No.: 'W c d fiD 3_ Screen Length (from) (to�Ft6) <br /> Filter Pack (from) <br /> inspector. 5,wh32 3�f Bentonite (from) (to)_ <br /> 9vt�35': Grout (from_E_(to)_ <br /> Drilling rig type <br /> Permit No. a3-3O Auger O.D. I.D. <br /> Drilling Company: �. bt /( <br /> woo Comple don - Stove pipe/cluisde box (cirde one) r <br /> Driller:_ v an(o p <br /> ("!•i <br /> Consultant_. U 12S - <br /> Geologist_ SC0-4 Lmr�Lw 2/(�r l 1 <br /> grout <br /> SPECIAL PERMIT INFO, seal <br /> Distance to sewer line I`S ft. <br /> - - - - ,eft. <br /> Domestic well.on site - <br /> lf yes, location and ante - <br /> gravel pack <br /> a <br /> ft. <br /> SAMPLING <br /> seal <br /> Hold ingTempera ture min.nwrl�' ov !G <br /> - <br /> Screening Method <br /> Tracking Sheet - n ) — gravel pack <br /> SPOILS <br /> ft.. <br /> Storage Method J�Z, of MATERIALS/DEVELOPMENT <br /> ContmInation Noted - (Vn) <br /> Storage Location rnAS, r ,, Casing type Qtly ? PUC <br /> Blank fc Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> MIX Ratios Filter Pack type/size ,� _ <br /> -installation Method Surge Block: - (y/ 1 <br /> Quantity installed Discussed vAth geologist: - (yam) <br /> Type of method <br /> EH 2929 . <br />