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MONITORING WELL INSTALLATION REPORT <br /> Date:_ 3d �/ CONSTRUCTION <br /> Premise Address:_ A30 /U , aLl-,k 6l 5T . c4v Total Depth � FY,"f- <br /> Screen Length (from)' /S _(to) <br /> l_ <br /> Well No.:_ (J&J /, ,� ()Gy-3w-y Filtet Pack (from)_ 13 : (to). <br /> J. YD�iCUM Bentonite' (from)_ l(1 (to) 11.?e <br /> Inspector: Grout (from) (to) let, <br /> !)'��G SZ Drilling rig type C,M 4P 7 - <br /> Permit No. Auger O.D. ,2 k w/9I.D._ <br /> Drilling Company:. <br /> Completion- Stove pipe/christie box (circle one) <br /> /j� <br /> Driller:_ <br /> casing <br /> height <br /> Consultant <br /> Geologist 60, L177-4,it ._ABOVE-GROUND <br /> COh3F'LET}ON ly <br /> SPECIAL PERMIT INFO. Ground Suncca <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n) <br /> If yes, location and distance - �� ft. <br /> ZZ ft. <br /> SAMPLING — o <br /> s to ttad = c <br /> Holding Temperature <br /> Method — VaV'W Pack <br /> Screening Method _ <br /> Tracking Sheet - (y/n) <br /> SPOILS Q / <br /> Storage Method ` ►1 l� MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) ) t� <br /> Storage Location Casing type & <br /> Blank i r-5 ft. Screen_ 3rd ft. <br /> Slot size_ 6. 1),1 <br /> GROUTING Bags cement !y 2 n LL N -- <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method_ <br /> Quantity Installed Discussed with geo ogist: - (31"/-n ) <br /> EH 29 29 <br /> Type of method <br /> ' <br />