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MONITORING WELL INSTALLATION REPORT <br /> Date:_ o'� Q0 I LI CONSTRUCTION <br /> Premise Address:_ `b00 C-t-►"rc V-x S4 .lei 74o k-Vo r, CA Total Depth <br /> _ Screen Length (from) (to) <br /> Well No.: _ �hJ Filter Pack (from) (to)___ <br /> Bentonite (from) (to) <br /> Inspector: _75 e yt3c 1,c—uyy-, Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: Completion - Stove pipe/christie box (circle one) <br /> Driller: �hcasing <br /> height <br /> Consultant <br /> Geologist Q_n _Xye� ,_ <br /> ABOVE-GROUND <br /> COMPLETION CHRfS'TY-80X <br /> SPECIAL PERMIT INFO. Gond Surface COMPLETION <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n ) <br /> If yes, location and distance - ft• <br /> ft. ft. <br /> — m <br /> A <br /> SAMPLING = <br /> sbttsd — <br /> s#cIon — <br /> Holding Temperature Ort- <br /> Method Ga' ;Vies; _ pack <br /> Screening Method IDa3O <br /> Tracking Sheet - n) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) <br /> Storage Location t�hn Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/n) <br /> Quantity Installed Discussed with geologist: - (y/ n) <br /> Type of method <br /> EH 29 29 <br />