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MONITORING WELL INSTALLATION REPORT <br /> Date: I . $` l5 CONSTRUCTION <br /> Premise Address: G08 L18 1 p s ROM Total Depth �n d <br /> Screen Length (from) 3o (to) 6g <br /> Well No.: (/W – \ Filter Pack (from) —"Z8- (to) C,a <br /> Bentonite (from) -2-1 (to) Zfi <br /> Inspector: J.yO��wM Grout (from) d (to) Z4f <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: <br /> Ca5c&A p^k '1 Completion - Stove pipe/christie box (circle one) <br /> ` <br /> Driller: TGt y <br /> - 7E=— casing <br /> I height <br /> Consultantuvc¢� + �p Zyt <br /> J . <br /> Geologist arklh '4/ <br /> ABOVE-GRCUND <br /> COWLETCN CHRLM-BOX <br /> SPECIAL PERMIT INFO. 6COMPLE'nON <br /> rcurxl Surface <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n) <br /> If yes, location and distance- <br /> = m <br /> — n <br /> = m <br /> SAMPLING — o` <br /> abtted — c <br /> sacion <br /> Holding Temperature — <br /> Method — brave Pact <br /> Screening Method = <br /> Tracking Sheet - (y/n) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted- (y/n) <br /> Storage Location Casing type TypLu <br /> Blank Sci ft. Screen 3U ft. <br /> Slot size O. OZc <br /> GROUTING Bags cement <br /> Buckets bentonite 2 � 5 <br /> Depth to water Bags sand/gravel 2,1 <br /> Mix Ratios Filter Pack type/size Z(tZ s <br /> Installation Method Surge Block: - (y/n) <br /> Quantity Installed Discussed with geologist: - (y/n) <br /> EH 29 29 Type of method <br />