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MONITORING WELL INSTALLATION REPORT <br /> Date: I )7-7-/13 CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from)' 10 If (to) 10 6 <br /> Well No.: A S-S Filter Pack (from) 101- (to) 11 1 <br /> Bentonite' (from) ri 7 (to) 10 2 <br /> Inspector• J•yy9;tlawl Grout (from) (to) ry 7 _ <br /> Drilling rig type GMF 4 r <br /> Permit No, SiP�(„(�pZz. Auger O.D. 8 i•„e ( I.D. <br /> Completion- Stove pipe/ • s 'e bo circle one) <br /> Drilling Company: Gc S c.,c(e <br /> Driller: casing <br /> height <br /> Consultant <br /> Geologist SIc G 19Ci_ 151+ V <br /> A80VE-GROUND <br /> oowLmON CHRZTY-Box <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Swfaco <br /> Distance to sewer line oro l <br /> Domestic well on site - (y/n) C1 7 <br /> If yes, location and distance - I 2 ft <br /> IuN ft. <br /> — m <br /> % <br /> SAMPLING _ <br /> dottad —_ c <br /> aacdon _ <br /> Holding Temperature <br /> Method " __ Q""W P3CK <br /> Screening Method .72 <br /> —_ <br /> Tracking Sheet - (y/n) <br /> 10( ft __ <br /> It. fl. <br /> SPOILS <br /> 111 •C4 __ S``"/' <br /> Storage Method MATERIALS/DEVFLOPMENT <br /> Contamination Noted - (y/n) <br /> Storage Location Casing type 7- Scl. &o PVc <br /> Blank 10 '9 ft. Screen 'L ft. <br /> Slot size 0. 010 "'CL <br /> GROUTING Bags cement <br /> Buckets bentonite 2 •rb -!L I- s <br /> Depth to water Bags sand/gravel le p- (9 L_3 <br /> Mix Ratios Filter Pack typesize <br /> Installation Method Surge Block:._(.y Ln-)---- <br /> Quantity <br /> n_)_--Quantity Installed" Discussed with geologist: - (y/ n) <br /> EH 29 29 Type of method <br />