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MONITORING WELL INSTALLATION REPORT <br /> Date: rJ` 2�j ��} �&&� �V � �`T CONSTRUCTION <br /> Premise Address: _L R{1NJt - lacy Total Depth 31,5 <br /> Screen Length (from) (to) <br /> Zq- <br /> Well No.: - Filter Pack (from) (to) 2 2 <br /> Bentonite (from) 24 (to) Zl. <br /> Inspector: `•: AC J Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company:_ (I.{ <br /> QC �^'�� ( C,�: Completio - S pi /christie box (circle one) <br /> UK 19�1 - <br /> Driller: casing <br /> height <br /> Consultant '4 <br /> Geologist C*k lsu-L .- <br /> (� ABOVE-GACUND <br /> COhFL.cT10N CNAtSTY-8cX <br /> SPECIAL PERMIT INFO. Ground Sur<xs coMPt�mc� <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ ft. <br /> If yes, location and distance - f!- <br /> ft. <br /> A <br /> SAMPLING <br /> 5I0C•ad <br /> Holding Temperature _ F <br /> Method <br /> Screening Method <br /> Tracking Sheet - ( y/ n ) <br /> ft. <br /> tee. tI. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y n <br /> Storage Location Casing type t'n L 4"5 <br /> Blank Z ft. Screen 110 ft. <br /> Slot size © 2 <br /> GROUTING Bags cement <br /> Buckets bentonite 3 V <br /> Depth to water Bags sand/gravel <br /> Mix Ratios • W 4kC Filter Pack type/size <br /> Installation Method - Surge Block: - ((�/ n ) <br /> Quantity Installed Discussed with eologis <br /> Type of method <br /> EH 29 29 <br />