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MONITORING WELL INSTALLATION REPORT <br /> Date: �/2 Z �/Z CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) log (to) no <br /> Well No.: AS-6 Filter Pack (from) 106 (to) IU,r <br /> Bentonite (from) lot (to)--I o L <br /> Inspector: Grout (from) I (to) l0 1 <br /> Drilling rig type Lrg r 4f <br /> Permit No. Auger O.D. r`.cl. I.D. <br /> Completion- Stove pipe "s ie box circle one) <br /> Drilling Company: Cas c.clo <br /> TO la z+� casing <br /> Drille[: r . <br /> 1 height <br /> Consultant fI R CA �7S <br /> Geologist t—t.L ABOVE-GROUND <br /> CHAISTY�OX <br /> CONPLErnN COMPLETION <br /> SPECIAL PERMIT INFO. t3round Surface -- <br /> grout <br /> Distance to sewer line 1 p l - ft <br /> Domestic well on site - (y/ n) <br /> If yes, location and distance - log ft. <br /> fOk ft. <br /> C <br /> SAMPLING eiac�on <br /> :'ra — <br /> Holding Temperature <br /> Method <br /> Screening Method = ' <br /> Tracking Sheet - (y/n) s <br /> SPOILS IIS f+ <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) Casing type Z r' SC. PVC <br /> Storage Location Blank 1g& ft. Screen___2 ft. <br /> Slot size O o I J — <br /> GROUTING Bags cement <br /> Buckets bentonite 2 SO 1 L 1"..j <br /> t <br /> Depth to water Bags sand/gravel to o-1 L + <br /> Mix Ratios Filter Packtype/size Z /Z S++e — <br /> Installation Method <br /> ---___--- Surge Slock:-_(.y-/—n_)-.— -- <br /> Discussed with geologist: - (y/ n ) <br /> Quantity Installed <br /> Type of method <br /> EH 29 29 <br />