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MONITORING WELL INSTALLATION REPORT <br /> Date: h I j0 0-K- CONSTRUCTION <br /> Premise Address: �S �/�� � �� Total Depth ✓6 <br /> Screen Length (from) to) 401w y9 <br /> Well No.: S Filter Pack (from) (to) <br /> Bentonite (from) L( (to) <br /> Inspector. bdjAAr'� Grout (from) (to) Y5" <br /> �/! Dulling rig type <br /> Permit No. 5 l b�-6 Auger O.D. 4S " I.D. <br /> Completion-Stove pipe/christie box (circle one) <br /> Drilling Company: /2 5 <br /> Duller: / casing <br /> height <br /> Consultant <br /> Geologic A3CY RC(JND <br /> CNRSST'-3CX <br /> SPECIAL PEIR- T INFO. Cv=jnd SLTf7C! 4 <br /> Distance to sewer line <br /> Domestic well on site - /n) '� w <br /> If yes, location sire <br /> - <br /> r � C <br /> C <br /> SAMPI_.ING Waned = c <br /> sawn = <br /> Holding Temperature F <br /> Method <br /> Screening Method _ <br /> Tracking Sheet - (y/ n) <br /> _1:L:L ♦ _ ♦ �`C) f <br /> i <br /> SPOILS <br /> Storage Method S S� `'� MATERIAIS/DEVELOPMENT <br /> Contamination Noted - y nCasing type "- e <br /> Storage Location <br /> Blank `I-� fr- Screen Z' ft. <br /> Slot size 0,0?-r-7 <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water <br /> �v 5 \ Bags sand/gravel <br /> Mix Rarios K- Filter Pack typesize z <br /> Installation Method Surge Block - (y/ <br /> Quantity Installed Discussed with geology - (y/6) <br /> Type of method <br /> EH 29 29 <br />