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MONITORING WELL INSTALLATION REPORT <br /> Date: t-6 CONSTRUCTION <br /> PrerniseAddress: Total Depth <br /> Screen Length (from) 4( <br /> Well No.: J1,A W- 'j- y1A W M L4-) Filter Pack (from) y '-5— (to) g'-t' <br /> Bentonite (from) 3 (to) <br /> Inspector: Grout (from), <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: tr�' & E r, <br /> Driller: casing <br /> height <br /> ConsLfltant <br /> Geologist WWLI"Ood - V111i4od"PkA T <br /> ABOVE-GRCUND <br /> OCNIFLC-FiF;ETC ISTY-BOX <br /> CO&IPLETICN <br /> SPECIAL, PERMIT INFO. Ground Salace <br /> Distance to sewer-line procrt <br /> Domestic well on site y n <br /> If yes, location and d fidnce (4 S- <br /> ft. <br /> O <br /> SAMPLING <br /> 1-folding Terrlperat U)— <br /> Method t2s3r <br /> 'C""I tv, V4-4- <br /> Screening Method <br /> Tracking Sheet f y n <br /> ft. <br /> SPOILS <br /> Storage Method t���t vet_, MATERIALS/DEVELOPMENT <br /> Contamination Noted - y 01-0 <br /> Storage Location_ Casing type 2 s rl C <br /> Blank--- 3, ft. Screen--Z-6--ft. <br /> Slot size , 0-2_C <br /> GROUTING Bags cement—.--.-- <br /> Buckets bentonite---- <br /> Df'P[h to Bags <br /> Mix Filter Pack type/size-- <br /> Installation Surge Block: - ( Y /61 <br /> Quantity Installed_ Discussed with geologist: y// n <br /> Type ype of method <br /> EH29 29 <br />