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MONITORING WELL INSTALLATION REPORT <br /> Date: I 6,K CONSTRUCTION <br /> Premise Address: ( �^(�� C �, Total Depth �s <br /> Screen Length (from) (to) <br /> Well No.: VVI W- 1 C Filter Pack (from) S2-J- <br /> Bentonite (from) (to) Sz.q <br /> Inspector: TJ c Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: �l�.�n���{� <br /> Driller:_ casing <br /> height <br /> ConsultantVX <br /> M. W, <br /> Geologist C� �o�df <br /> l ABOVE-GROUND <br /> CO W LETIO N CHR ISTY-8OX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surfacs <br /> Distance to sewer line proof <br /> Domestic well o e - (y/ n ) <br /> If yes, locati and distance - <br /> ft. ft. <br /> C <br /> SAMPLING = <br /> �to tied � <br /> asc'ion = <br /> Holding Temperature dV,, \,(-S <br /> Method 6" g ylc�.d� �1 moi_ ,�o�_ — ref pacts <br /> Screening Method -- <br /> Tracking Sheet /n ) =11aw — <br /> ft. <br /> SPOILS <br /> Storage Method_ G c MATERIALS/DEVELOPMENT <br /> Contamination Noted - <br /> Storage Location Casing type 2 Sc/Iti \4e) pV <br /> Blank 55 ft. Screen ft. <br /> Slot size [e� <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel v Z•5 Qic <br /> Mix Ratios Filter Pack type/size z f � /( <br /> Installation Method41" s Surge Block: - ( y/ n ) <br /> Quantity Installed Discussed with geologist: ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />