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MONITORING WELL INSTALLATION REPORT <br /> c5h& � <br /> Date: � qh* F//� `_ CONSTRUCTION <br /> Premise Address: yf_u�_ u � Total Depth I <br /> Screen Length (from) (to) 130 <br /> Well No.: 6` -I � Filter Pack (from 3 /q .5-135(to) e) 'I <br /> Bentonite (from) 134 (to) 1 <br /> Inspector: w_-, Grout i+gl.(from) IZ - (to)=I O <br /> Drilling ri e (/0L1,RQ-skU- I i-tDO <br /> Permit No. Z Auger O.D. J I.D. <br /> Completion ZS A�pluistie box (circle one) <br /> Drilling Company:_ <br /> Driller: casing <br /> he, <br /> Consultant PTA I <br /> 7, <br /> Geologist IL <br /> •" <br /> ABCVE-GAMND CHSZTY43OX <br /> COMPLETION CCMPLETICN <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line gf <br /> out <br /> Domestic well on site - (y/ n �_ft. <br /> If yes, location and distance - n- <br /> It. <br /> — o <br /> SAMPLING aloroi <br /> saricn — <br /> B <br /> Holding Temperature = pav91 pack <br /> Method <br /> Screening Method = <br /> Tracking Sheet - (y/ n ) <br /> ft- <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) <br /> Storage Location Casing type <br /> Blank I(eO ft. Screen <br /> Slot size 0 Z <br /> GROUTING Bags cement � <br /> ,{ )(Buckets bentonite <br /> Depth to water `T Bags sand/gravel <br /> Mix Ratios- _ Filter Pack type/ ize O <br /> Installation Method Surge Block: - y nn <br /> Quantity Installed 16t 4 6 Discussed with ge log'st: - y n ) <br /> Type of method <br /> EH 29 29 <br />