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MONITORING WELL INSTALLATION REPORT <br /> Date:_ �[J f I L!' CONSTRUCTION <br /> Premise Address:_ 51)0 toch o rel,zl Total Depth g' <br /> Well No.:--� (/U Screen Length (from)' I n (to) S <br /> Filter Pack (from)_ _(to) $ <br /> Inspector: Bentonite (from) (to) (D` <br /> Grout (from) re V--..(tO) <br /> Permit No. <br /> W . 1 Drilling rig type tb tLt)S AAI - 11 <br /> X� Auger O.D. %" I.D. X14 i2 " <br /> Drilling Company: <br /> Completion- Stove pipe/christie box (circle one) <br /> Driller: c,-AM P t <br /> casing <br /> Consultantheight_��� �`��, ' <br /> —T <br /> Geologist -� <br /> ABOVE-GROUND <br /> CO WFLET{ON CNA JSTY-BOX <br /> SPECIAL PERMIT INFO COMPLEMN <br /> Ground Surface <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n) <br /> If yes, Iocation and distance - 4 ft. <br /> SAMPLING = o <br /> elcCtad — c <br /> Holding Temperature_ ►OmoP .n = <br /> Method e = VIVa{pacts <br /> Screening Method :a _ <br /> Tracking Sheet - (y/n) <br /> _1t. n- <br /> SPOILS � �( <br /> Storage Method aa )�/�yr_ m S l MATEgJALS/DEVELOPMENT <br /> Contamination Noted__ - (y/) �©) l�oW f e 4'W"?th <br /> Storage LocationSU6 , fy1�I,�V i a fica/ 17L <br /> IC" <br /> SC�t?� �� C <br /> "�- t Blank !0 ft. Screen_ it. <br /> Slot size 0,1011 <br /> GROUTING Bags cement <br /> Depth to water <br /> Buckets bentonite <br /> �5� Bags sand/gravel <br /> Mix Ratios <br /> Installation Method_ Filter Pack type/size_______. Surge_Block: - (.y_/n_) <br /> Quantity Installed Discussed with geologist: - (y/n) <br /> EH 29 29 Type of method <br />