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MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth_ �{ <br /> Screen Length (from) (to) <br /> Well No.: S - �` S P�o Filter Parc (from) 'LA U (to) <br /> Bentonite' (from)_ (to) y a <br /> Inspector: J - yytW Grout (from)_ ` (to) 3 <br /> Drilling rig type_('/V\e -7S <br /> Permit No. Auger O.D.- <br /> Drilling Company:_ J+w <br /> Completion - Stove pipe/ •'stie box circle one) <br /> Drillez:_ casing <br /> Consultantheight <br /> (, <br /> Geologist <br /> ABOVE-GROUND <br /> cawLmON CHRISTY-So <br /> SPECIAL PERMIT INFO COt,i ON <br /> r C3round Suri3c-e <br /> Distance to sewer line r- S grout <br /> Domestic well on site - (y n <br /> IF yes, location and distance - <br /> Y" m <br /> SAMPLING = o <br /> a to ttad <br /> iacaan — <br /> Holding Temperature_ 3 — <br /> Method C = Qr,,,s4 pack <br /> Screening Method T) <br /> Tracking Sheet /n) <br /> SPOILS <br /> Storage Method 9 S MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( /n) <br /> Storage Location DVS Casing type q,3Q S c\J. Kb <br /> Blank_ LA ":) ft. Screen 4 r• z. {t, <br /> GROUTING Slot size 'b , 0 Za <br /> r Bags cement 7 C9449S�) <br /> Depth to water Buckets bentonite 1 <br /> S Bags sand/gravel- 3 L181�5 <br /> Mix Ratios, if �y lhs L Filter Pack type/size <br /> Installation Method --T C L v\-\ _ ___ S.urge_Block:_=(-y_/ <br /> Quantity Installed Discussed withgeologist: / n) <br /> EH 29 29 Type of method_ A <br /> •- <br /> 0 <br />