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MONITORING WELL INSTALLATION REPORT <br /> Date: �1/ � '1 CONSTRUCTION <br /> Premise Address:_ n ,5L1 <br /> V Total Depth �� 5 <br /> Well No.: Screen Length (from)' (to) a <br /> Filter Pack (from) ��-(to) <br /> Bentonite' (from) (to) I <br /> Inspector: n Grout (from) (to) <br /> Drilling rig type lit' rn #14 11 <br /> Permit No." , Auger O.D. " I.D. l4 <br /> Drilling Company: i �(J <br /> Completion- Stove pipe/chnstie box (circle one) <br /> Driller: 'u�-- <br /> casing <br /> Consultant height <br /> _ ' <br /> Geologist_ 1 /11p A/ <br /> ABOVE-GROUND <br /> COMPLET)ON CNRIM-Sox <br /> SPECIAL PERMIT INFO. COMPLETION <br /> Ground Surface <br /> 0 <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n) <br /> If yes, location and distance - ft. <br /> ,a ft. <br /> SAMPLING — o <br /> SICtted _ <br /> iacdona <br /> Holding Temperature <br /> Cature <br /> II.I.V�J y,- <br /> Method _ 9Vq?Pack <br /> Screening Method '; = <br /> Tracking Sheet (y/n) '� <br /> .ii4..11. <br /> SPOILS <br /> Storage Method oZ" S MATERIAL.S/DEVELOPMENT <br /> Contamination Noted- y/ ) <br /> Storage Location Casing type '3r- � q0 Py <br /> Blank t. Screen /S ft. <br /> Slot size�_(� <br /> GROUTING Bags cement <br /> s Buckets bentonite <br /> Depth to water ""� Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method_ Block:-(_y_/_n_) <br /> Quantity Installed " Discussed with geologist: - (y/ n) <br /> EH 29 29 Type of method <br />