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MONITORING WELL INSTALLATION REPORT <br /> Date: Hy- 13 CONSTRUCTION p <br /> Premise Address: 25775 P.-Rern.. Psss Rd. T.c� Total Depth 6 <br /> Screen Length (from)' 110 (to) I I?_ <br /> Well No.: A S ' 3 R Filter Pack (from) lok (to) 118 <br /> Bentonite' (from) 10 % (to) )OE- <br /> Inspector: Grout (from) I (to) Imo_ <br /> Drilling rig type CH E 9S <br /> Permit No. S POD6(,D22 Auger O.D. R n I.D. 9.ZSR <br /> Completion- Stove pipe/chnstie box (circle one) <br /> Drilling Company: C ac c..le <br /> Driller: Tor N Se. U-L"_ casing <br /> height <br /> Consultant A R GA D:t _E <br /> S <br /> Geologist S�c yr l[ AL 'Le W <br /> ABOVE-GROUND <br /> COMPLEf10N CHAISTY-Box <br /> COMPLETION <br /> SPECIAL PERMIT INFO, Ground Surface <br /> Distance to sewer line ofout <br /> Domestic well on site - (y/ <br /> If yes, location and distance 03 ft' <br /> �r0og ft. <br /> h. <br /> ' � o <br /> SAMPLING totted g <br /> c <br /> Holding Temperature _ P <br /> Method �`+ —_ <br /> ack <br /> Screening Method — <br /> Tracking Sheet - (y/ ) ' <br /> SPOILS <br /> 117 fk v <br /> Storage Method �RIItMS �o MATERIAIS/DEVELOPMENT <br /> Contamination Noted - n) 1*1 <br /> Storage Location Casing type Z Scl, 00 PVC <br /> Blank 110 ft. Screen 2 ft. <br /> Slot size 0.010 <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size 1-/Iti Seal <br /> Installation MethodSyrge_Block:__(_y/-n-)- <br /> Quantity Installed <br /> /-n-)_QuantityInstalled Discussed with geologist: - (y/n) <br /> EH 29 29 Type of method <br />