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MONITORING WELL INSTALLATION REPORT <br /> Date: Ct] Z �C' CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) 2> '5^ ` (to) 'To r <br /> Well No.: I } (,1 ~ Z_ ,1M-Ot) - Filter Pack (from) '> (to) S <br /> Bentonite (from)_ _(to) Z,7;,Z ` <br /> Inspector. 4, ht A1 11 1-1 Grout (from) (to) -;?,C-) J <br /> Drilling rig type ('"`r <br /> Permit No. C 0 -2 3 Z. `� Auger O.D. X ` I.D. <br /> Completion - Stove pipe/�iristie box (circle one) <br /> Drilling Company: u <br /> Driller: casing <br /> 1 height <br /> Consultant <br /> Geologist ' -- <br /> A$C VE-GA CUND Ci-AZTY-a0X <br /> cor��=Tjo� c06APLrnCN <br /> SPECIAL PERMIT INFO. nraj�d Suel —� <br /> Distance to sewer line <br /> Domestic well on site - ( y-`"n <br /> i ) 3 Ifo <br /> Iyes, location and digance - ft- <br /> C <br /> O <br /> SAMPLING riora.i _ <br /> sccicn <br /> Holding Temperature - '� �,nvd pacts <br /> Method <br /> Screening Metes c' <br /> Tracking�Kcet - ( y/ n ) <br /> 0 It• ..M ite <br /> SPOILS <br /> Storage Method �' _ MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/(n j Z f <br /> Storage Location Casing type <br /> Blank 2, 5� ft. Screen `�� • <br /> Slot size C� � <br /> GROUTING Bags cement �a <br /> (` Buckets bentonite 1 <br /> Depth to water Bags sand/gravel <br /> Mix Ratios (v - Filter Pack type/size <br /> installation Method uw4... Surge Block: - (y/ ii ) <br /> Quantity Installed ,� Discussed with geologist: - ( y/ n ) <br /> Type of metliod <br /> EH 29 29 <br />