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MONITORING WELL INSTALLATION REPORT <br /> Date: �P'L'��' CONSTRUCTION <br /> Premise Address: \ l "-L rtk� C>I _. Total Depth 24-5 <br /> Screen Length (from) (to) Z/!o <br /> Well No.: �j5 ' (� Filter Pack (from) 3' 6-213 (to)4hbZ13-ZM6 <br /> Bentonite (from) 209.(0 (to) 2 4, <br /> Inspector: _ G �4SV�� Grout (from) Zl,.lo (to) b Z <br /> Drilling rig type <br /> Permit No. V �7i�7/� Auger O.D. i:;5 I.D. <br /> nn CompletionStove pip hristie box (circle one) <br /> Drilling Company:_ ��`l.^ C[., & ' p-3 2�— <br /> Driller: clnq <br /> height <br /> Consultant 'd <br /> Geologist •- <br /> ABOVE-GACUND <br /> t�MPt.1:TfON CNFi1STY-80X <br /> cOMPVmcN <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line <br /> grout <br /> Domestic well on site - (y/ ) ft. <br /> If yes, location and distance - <br /> ft. ft. <br /> SAMPLING <br /> Tocicn <br /> Holding Temperature <: <br /> Method <br /> Screening Method c; _ <br /> Tracking Sheet - ( y/ n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVEI.OPMENT <br /> Contamination Noted - (y On VC .`�if <br /> Storage Location Casing type <br /> Blank 7 _ft. Screen 10 ft. <br /> Slot size -O Z <br /> GROUTING 8 Bags cement <br /> Buckets bentonite_ To an <br /> Depth to water�' Bags sand/gravel <br /> Mix Ratios _ Filter Pack type/ ize Ce <br /> Installation Method Surge Block: - ' n ) <br /> Quantity Installed Discussed with ge ogi t: - y Y n ) <br /> Type of method <br /> EH 29 29 <br />